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Acute treatment of critical vascular stenoses with a bioabsorbable magnesium scaffold in infants with CHDs

Published online by Cambridge University Press:  21 February 2020

Peter A. Zartner Open the ORCID record for Peter A. Zartner [Opens in a new window] ,
Dietmar Schranz ,
Nathalie Mini ,
Martin B. Schneider  and
Katja Schneider
Peter A. Zartner*
Affiliation:
Department of Cardiology, German Paediatric Heart Centre, University Hospital, Bonn, Germany
Dietmar Schranz
Affiliation:
Department of Cardiology, Hessian Paediatric Heart Centre, University Giessen and Marburg, Giessen, Germany
Nathalie Mini
Affiliation:
Department of Cardiology, German Paediatric Heart Centre, University Hospital, Bonn, Germany
Martin B. Schneider
Affiliation:
Department of Cardiology, German Paediatric Heart Centre, University Hospital, Bonn, Germany
Katja Schneider
Affiliation:
Department of Neonatology, Marienhospital, Bonn, Germany
*
Author for correspondence: Dr P. Zartner, Department of Cardiology, German Paediatric Heart Centre, University Hospital of Bonn, Venusberg Campus 1, 53127Bonn, Germany. Tel: +49 228 287-37482; Fax: +49 228 287-14603; E-mail: peter.zartner@ukbonn.de
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Abstract

Background:

Post-operative severe vascular stenosis and proliferating endothelial tissue lead to severe circulatory disorders and impair organ perfusion. Bioabsorbable magnesium scaffolds may help to overcome these obstructions without leaving obstructing stent material. We analyse their role in the treatment of vascular stenosis in infants.

Methods:

Since 2016, 15 magnesium scaffolds with a diameter of 3.5 mm were implanted in 9 patients aged 15 days to 7.6 years. Eight scaffolds were implanted in pulmonary venous restenoses, five in pulmonary arterial stenosis including one in-stent stenosis, one into a stenotic brachiocephalic artery, and one in a recurrent innominate vein thrombosis.

Results:

All patients clinically improved after the implantation of a scaffold. The magnesium scaffolds lost integrity after 30–48 days (mean 42 days). The innominate vein thrombosed early, while all other vessels remained open. Two patients died after 1.3 and 14 weeks not related to the scaffolds. Five patients needed further balloon dilations or stent implantations after the scaffold had fractured. At first recatheterisation after in mean 2.5 months, the mean minimum/maximum diameter in relation to the scaffold’s original diameter was 89%/99% in the arterial implantations (n = 6) and 66%/77% in the pulmonary venous implantations.

Conclusions:

The magnesium scaffolds can be used as a bridging solution to treat severe vascular stenosis in different locations. Restenosis can occur after degradation and make further interventions necessary, but neither vessel growth nor further interventions are hindered by stent material. Larger diameters may improve therapeutic options.

Keywords

stent implantationcritical vascular stenosisemergency interventiondrug-eluting stentbioabsorbable metals
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 4 , April 2020 , pp. 493 - 499
Copyright
© The Author(s) 2020. Published by Cambridge University Press

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