Sullivan PM, et al. – This study describes the experience and outcomes tailoring stents to fit unique anatomy, particularly in small children and infants with congenital heart disease (CHD). In small patients, implantation of the tailored stents to fit unique anatomy appeared safe. Additionally, re–interventions could effectively treat restenosis and accommodated ongoing vessel growth.

Methods

• Stent tailoring techniques included trimming, folding, and flaring.
• A retrospective analysis was performed including patients receiving a tailored stent November 2002 to February 2015.

Results

• Data reported that 41 tailored stents were implanted in 30 patients with median age and weight of 0.8 years (6 days to 17 years) and 8.1 kg (2.9–47.9 kg).
• It was noted that 30 stents were placed intraoperatively and 11 percutaneously.
• Sites included branch pulmonary arteries (BPA; n = 32), pulmonary veins (n = 6), SVC (n = 1), and the ventricular septum (n = 2).
• Findings demonstrated that twenty-three (56%) stents were trimmed with or without folding to avoid jailing of side branches, 16 (39%) stents were folded or flared with or without trimming to avoid excessive proximal protrusion, and two (5%) stents were folded back at both ends for implantation in ventricular septal defects.
• As per the data, final stent lengths were 6–15 mm and minimal vessel diameters increased from 2.8 ± 1.4 mm to 6.7 ± 2.6 mm (P<0.001).
• In addition, two intraoperative BPA tears, three pinhole balloon leaks, two intraoperative stent dislodgements, one transient heart block, and one lung reperfusion injury were identified as complications.
• Data highlighted that follow-up catheterization included 36 re-dilations and implantation of four additional stents over a median of 4.1 years.
• Also, in 25 (69.4%) re-interventions, in-stent restenosis was the indication.