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Erschienen in: Heart and Vessels 2/2021

05.09.2020 | Original Article

Clinical trial of the CP stent for pulmonary artery stenosis: the first investigator-initiated clinical trial for pediatric interventional cardiology in Japan

verfasst von: Takanari Fujii, Hideshi Tomita, Toshiki Kobayashi, Hitoshi Kato, Hisashi Sugiyama, Ayumi Mizukami, Hideaki Ueda

Erschienen in: Heart and Vessels | Ausgabe 2/2021

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Abstract

Stenting is an important treatment option for pulmonary artery stenosis (PS) associated with congenital heart disease (CHD). However, no stent has been approved for this indication in Japan, despite negotiation between academia and the regulatory bodies for longer than 20 years. To evaluate efficacy and safety of the CP stent, we performed the first investigator-initiated clinical trial for pediatric interventional cardiology in Japan. This trial was designed as a single-arm, prospective, clinical trial. Patients who had postoperative PS associated with CHD were included. Stenting was attempted in 24 cases and succeeded in 22 cases. The median age of the patients was 11 years (3–36 years) and weight was 38 kg (12–69 kg), while follow-up for 12 months was completed. In all 22 cases, stenting was successful, with a 50% increase in the minimum lumen diameter (MLD) in 86.4% of patients (90% confidence interval, 68.4–96.2%). The mean percent change in MLD was 119.3 ± 52.5%. In two-ventricle repair, the mean percent change in systolic right ventricular/aortic pressure was − 8.5 ± 16.1%, while that of pressure gradient was − 55.9 ± 41.7%. In single-ventricle repair, the percent change in the mean pressure gradient was − 100.0 ± 0%, while that of SaO2 was 1.4 ± 1.7%. No serious adverse events or significant restenosis was reported. The CP stent is highly effective and safe for PS associated with CHD. This study has significant importance in not only scientific but also social considerations.
Literatur
1.
Zurück zum Zitat Garson A Jr, Nihill MR, McNamara DG, Cooley DA (1979) Status of the adult and adolescent after repair of tetralogy of Fallot. Circulation 59:1232–1240CrossRef Garson A Jr, Nihill MR, McNamara DG, Cooley DA (1979) Status of the adult and adolescent after repair of tetralogy of Fallot. Circulation 59:1232–1240CrossRef
2.
Zurück zum Zitat Myers PO, Tissot C, Beghetti M (2014) Assessment of operability of patients with pulmonary arterial hypertension associated with congenital heart disease. Circ J 78:4–11CrossRef Myers PO, Tissot C, Beghetti M (2014) Assessment of operability of patients with pulmonary arterial hypertension associated with congenital heart disease. Circ J 78:4–11CrossRef
3.
Zurück zum Zitat Oyen WJ, van Oort AM, Tanke RB, van Mill GJ, Aengevaeren WR, Corstens FH (1995) Pulmonary perfusion after endovascular stenting of pulmonary artery stenosis. J Nucl Med 36:2006–2008PubMed Oyen WJ, van Oort AM, Tanke RB, van Mill GJ, Aengevaeren WR, Corstens FH (1995) Pulmonary perfusion after endovascular stenting of pulmonary artery stenosis. J Nucl Med 36:2006–2008PubMed
4.
Zurück zum Zitat Chaturvedi RR, Kilner PJ, White PA, Bishop A, Szwarc R, Redington AN (1997) Increased airway pressure and simulated branch pulmonary artery stenosis increase pulmonary regurgitation after repair of tetralogy of Fallot. Real-time analysis with a conductance catheter technique. Circulation 95:643–649CrossRef Chaturvedi RR, Kilner PJ, White PA, Bishop A, Szwarc R, Redington AN (1997) Increased airway pressure and simulated branch pulmonary artery stenosis increase pulmonary regurgitation after repair of tetralogy of Fallot. Real-time analysis with a conductance catheter technique. Circulation 95:643–649CrossRef
5.
Zurück zum Zitat Feltes TF, Bacha E, Beekman RH 3rd, Cheatham JP, Feinstein JA, Gomes AS, Hijazi ZM, Ing FF, de Moor M, Morrow WR, Mullins CE, Taubert KA, Zahn EM (2011) Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 123:2607–2652CrossRef Feltes TF, Bacha E, Beekman RH 3rd, Cheatham JP, Feinstein JA, Gomes AS, Hijazi ZM, Ing FF, de Moor M, Morrow WR, Mullins CE, Taubert KA, Zahn EM (2011) Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 123:2607–2652CrossRef
6.
Zurück zum Zitat Tomita H, Nakanishi T, Hamaoka K, Kobayashi T, Ono Y (2010) Stenting in congenital heart disease: medium- and long-term outcomes from the JPIC stent survey. Circ J 74:1676–1683CrossRef Tomita H, Nakanishi T, Hamaoka K, Kobayashi T, Ono Y (2010) Stenting in congenital heart disease: medium- and long-term outcomes from the JPIC stent survey. Circ J 74:1676–1683CrossRef
7.
Zurück zum Zitat Fujii T, Tomita H, Fujimoto K, Otsuki S, Kobayashi T, Ono Y, Yazaki S, Kim SH, Nakanishi T (2016) Morphological and hemodynamic effectiveness of stenting for pulmonary artery stenosis—subanalysis of JPIC stent survey. Circ J 80:1852–1856CrossRef Fujii T, Tomita H, Fujimoto K, Otsuki S, Kobayashi T, Ono Y, Yazaki S, Kim SH, Nakanishi T (2016) Morphological and hemodynamic effectiveness of stenting for pulmonary artery stenosis—subanalysis of JPIC stent survey. Circ J 80:1852–1856CrossRef
8.
Zurück zum Zitat Fujii T, Tomita H, Fujimoto K, Otsuki S, Kobayashi T, Ono Y, Yazaki S, Kim SH, Nakanishi T (2014) Stenting for pulmonary artery stenosis complicated by univentricular physiology: subanalysis of JPIC stent survey. J Cardiol 64:324–327CrossRef Fujii T, Tomita H, Fujimoto K, Otsuki S, Kobayashi T, Ono Y, Yazaki S, Kim SH, Nakanishi T (2014) Stenting for pulmonary artery stenosis complicated by univentricular physiology: subanalysis of JPIC stent survey. J Cardiol 64:324–327CrossRef
9.
Zurück zum Zitat Fujii T, Tomita H, Fujimoto K, Otsuki S, Kobayashi T, Ono Y, Yazaki S, Kim SH, Nakanishi T (2016) Current trends in stenting for aortic coarctation in Japan: subanalysis of Japanese Society of Pediatric Interventional Cardiology (JPIC) stent survey. Pediatr Int 58:100–104CrossRef Fujii T, Tomita H, Fujimoto K, Otsuki S, Kobayashi T, Ono Y, Yazaki S, Kim SH, Nakanishi T (2016) Current trends in stenting for aortic coarctation in Japan: subanalysis of Japanese Society of Pediatric Interventional Cardiology (JPIC) stent survey. Pediatr Int 58:100–104CrossRef
10.
Zurück zum Zitat Ewert P, Schubert S, Peters B, Abdul-Khaliq H, Nagdyman N, Lange PE (2005) The CP stent—short, long, covered—for the treatment of aortic coarctation, stenosis of pulmonary arteries and caval veins, and Fontan anastomosis in children and adults: an evaluation of 60 stents in 53 patients. Heart 91:948–953CrossRef Ewert P, Schubert S, Peters B, Abdul-Khaliq H, Nagdyman N, Lange PE (2005) The CP stent—short, long, covered—for the treatment of aortic coarctation, stenosis of pulmonary arteries and caval veins, and Fontan anastomosis in children and adults: an evaluation of 60 stents in 53 patients. Heart 91:948–953CrossRef
11.
Zurück zum Zitat Agnoletti G, Marini D, Ou P, Vandrell MC, Boudjemline Y, Bonnet D (2009) Cheatham platinum (CP) and Palmaz stents for cardiac and vascular lesions treatment in patients with congenital heart disease. EuroIntervention 4:620–625CrossRef Agnoletti G, Marini D, Ou P, Vandrell MC, Boudjemline Y, Bonnet D (2009) Cheatham platinum (CP) and Palmaz stents for cardiac and vascular lesions treatment in patients with congenital heart disease. EuroIntervention 4:620–625CrossRef
12.
Zurück zum Zitat Meadows J, Minahan M, McElhinney DB, McEnaney K, Ringel R (2015) Intermediate outcomes in the prospective, multicenter Coarctation of the Aorta Stent Trial (COAST). Circulation 131:1656–1664CrossRef Meadows J, Minahan M, McElhinney DB, McEnaney K, Ringel R (2015) Intermediate outcomes in the prospective, multicenter Coarctation of the Aorta Stent Trial (COAST). Circulation 131:1656–1664CrossRef
13.
Zurück zum Zitat Taggart NW, Minahan M, Cabalka AK, Cetta F, Usmani K, Ringel RE (2016) Immediate outcomes of covered stent placement for treatment or prevention of aortic wall injury associated with coarctation of the aorta (COAST II). JACC Cardiovasc Interv 9:484–493CrossRef Taggart NW, Minahan M, Cabalka AK, Cetta F, Usmani K, Ringel RE (2016) Immediate outcomes of covered stent placement for treatment or prevention of aortic wall injury associated with coarctation of the aorta (COAST II). JACC Cardiovasc Interv 9:484–493CrossRef
14.
Zurück zum Zitat Yoshimoto J, Inuzuka R, Matsui H, Kim SH, Miyata H, Suda K, Sugiyama H, Tomita H, Yazaki S, Kobayashi T, Otsuki S (2018) Pediatric and congenital catheter interventions and ablations in Japan during 2017: Annual report from Japanese Pediatric Interventional Society Database (JPIC-DB). J JPIC 3:43–55 Yoshimoto J, Inuzuka R, Matsui H, Kim SH, Miyata H, Suda K, Sugiyama H, Tomita H, Yazaki S, Kobayashi T, Otsuki S (2018) Pediatric and congenital catheter interventions and ablations in Japan during 2017: Annual report from Japanese Pediatric Interventional Society Database (JPIC-DB). J JPIC 3:43–55
15.
Zurück zum Zitat Rothman A, Perry SB, Keane JF, Lock JE (1990) Early results and follow-up of balloon angioplasty for branch pulmonary artery stenoses. J Am Coll Cardiol 15:1109–1117CrossRef Rothman A, Perry SB, Keane JF, Lock JE (1990) Early results and follow-up of balloon angioplasty for branch pulmonary artery stenoses. J Am Coll Cardiol 15:1109–1117CrossRef
16.
Zurück zum Zitat Shaffer KM, Mullins CE, Grifka RG, O'Laughlin MP, McMahon W, Ing FF, Nihill MR (1998) Intravascular stents in congenital heart disease: short- and long-term results from a large single-center experience. J Am Coll Cardiol 31:661–667CrossRef Shaffer KM, Mullins CE, Grifka RG, O'Laughlin MP, McMahon W, Ing FF, Nihill MR (1998) Intravascular stents in congenital heart disease: short- and long-term results from a large single-center experience. J Am Coll Cardiol 31:661–667CrossRef
17.
Zurück zum Zitat Fogelman R, Nykanen D, Smallhorn JF, McCrindle BW, Freedom RM, Benson LN (1995) Endovascular stents in the pulmonary circulation. Clinical impact on management and medium-term follow-up. Circulation 92:881–885CrossRef Fogelman R, Nykanen D, Smallhorn JF, McCrindle BW, Freedom RM, Benson LN (1995) Endovascular stents in the pulmonary circulation. Clinical impact on management and medium-term follow-up. Circulation 92:881–885CrossRef
18.
Zurück zum Zitat Hosking MC, Thomaidis C, Hamilton R, Burrows PE, Freedom RM, Benson LN (1992) Clinical impact of balloon angioplasty for branch pulmonary arterial stenosis. Am J Cardiol 69:1467–1470CrossRef Hosking MC, Thomaidis C, Hamilton R, Burrows PE, Freedom RM, Benson LN (1992) Clinical impact of balloon angioplasty for branch pulmonary arterial stenosis. Am J Cardiol 69:1467–1470CrossRef
Metadaten
Titel
Clinical trial of the CP stent for pulmonary artery stenosis: the first investigator-initiated clinical trial for pediatric interventional cardiology in Japan
verfasst von
Takanari Fujii
Hideshi Tomita
Toshiki Kobayashi
Hitoshi Kato
Hisashi Sugiyama
Ayumi Mizukami
Hideaki Ueda
Publikationsdatum
05.09.2020
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 2/2021
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-020-01691-0

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