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Initial use of endothelial progenitor cells capturing stents in paediatric congenital heart disease

Published online by Cambridge University Press:  18 September 2013

Nuno Cabanelas ,
José D. F. Martins  and
Fátima Pinto
Nuno Cabanelas*
Affiliation:
Department of Cardiology, Santarém Hospital, Santarém, Portugal
José D. F. Martins
Affiliation:
Department of Pediatric Cardiology, Santa Marta Hospital, Central Lisbon Hospital Center, Lisbon, Portugal
Fátima Pinto
Affiliation:
Department of Pediatric Cardiology, Santa Marta Hospital, Central Lisbon Hospital Center, Lisbon, Portugal
*
Correspondence to: N. Cabanelas, Serviço de Cardiologia do Hospital Distrital de Santarém, Avenida Bernardo Santareno, 2000 Santarém, Portugal. Tel: +351 966431810; Fax: +351 243300279; E-mail: [email protected]
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Abstract

Introduction

Stenosis, mediated by neointimal hyperplasia and thrombosis, is a major limiting factor in successful stent implantation. The introduction of a stent, coated in its endoluminal surface by antihuman CD34 antibodies with endothelial progenitor cell-capturing properties, opens the possibility of promoting a rapid and normal functioning coverage by endothelium and thus avoids both an excessive cell proliferation within stent and the need for long-term dual antiplatelet therapy. These stents, developed for adult coronary artery disease, have not yet been implanted in children or in those with congenital heart disease.

Objective and methods

In this paper, we describe the implantation of Genous® stents in three children with cyanotic congenital heart disease and obstructed systemic-to-pulmonary shunts. We describe the use of this stent and address its potential feasibility in paediatric congenital heart disease.

Results

To maintain the patency of two modified Blalock–Taussig shunts and one ductus arteriosus, four Genous® stents were implanted in three infants with cyanotic heart disease. All procedures were immediately successful, with resolution of stenosis and improvement in transcutaneous oxygen saturation from 66% ± 3.6% to 92% ± 2.6%. In the follow-up, one stent had no occlusion; however, the remaining two had partial occlusion after 5 and 5.5 months, which were successfully managed with balloon dilatation preceding elective definitive surgical correction.

Conclusion

In our preliminary experience, we demonstrated that Genous® stent implantation was feasible in infants with complex congenital heart disease. Additional studies with larger samples and longer follow-up are required to confirm the potential benefits of this technology in this clinical setting.

Keywords

Endothelial progenitor cells capturing stentductus arteriosus stentBlalock–Taussig shunt stenting
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 5 , October 2014 , pp. 900 - 904
Copyright
Copyright © Cambridge University Press 2013 

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References

1. Al Jubair, K, Al Fagih, M, Al Jarallah, A, et al. Results of 546 Blalock–Taussig shunts performed in 478 patients. Cardiol Young 1998: 486–490.Google Scholar
2. Gedicke, M, Morgan, G, Parry, A, et al. Risk factors for acute shunt blockage in children after modified Blalock–Taussig shunt operations. Heart Vessels 2010; 25: 405–409.CrossRefGoogle ScholarPubMed
3. Ahmad, U, Fatimi, S, Nagyi, I, et al. Modified Blalock–Taussig shunt: immediate and short-term follow-up results in neonates. Heart Lung Circ 2008; 17: 54–58.Google Scholar
4. Qureshi, S. Catheterization in neonates with pulmonary atresia with intact ventricular septum. Catheter Cardiovasc Interv 2006; 67: 924–931.Google Scholar
5. Santoro, G, Gaio, G, Palladino, M, et al. Arterial duct stenting: do we still need surgical shunt in congenital heart malformations with duct-dependent pulmonary circulation? J Cardiovasc Med Hagerstown 2010; 11: 852–857.Google Scholar
6. Schranz, D, Michel-Behnke, I, Heyer, R, et al. Stent implantation of the arterial duct in newborns with a truly duct-dependent pulmonary circulation: a single-center experience with emphasis on aspects of the interventional technique. J Interv Cardiol 2010; 23: 581–588.Google Scholar
7. Santoro, G, Gaio, G, Palladino, M, et al. Stenting of the arterial duct in newborns with duct-dependent pulmonary circulation. Heart 2008; 94: 925–929.Google Scholar
8. Hussain, A, Al-Zharani, S, Muhammed, A, et al. Midterm outcome of stent dilatation of patent ductus arteriosus in ductal-dependent pulmonary circulation. Congenit Heart Dis 2008; 3: 241–249.Google Scholar
9. Alwi, M. Stenting the ductus arteriosus: case selection, technique and possible complications. Ann Pediatr Cardiol 2008; 1: 38–45.Google Scholar
10. Gillespie, M, Rome, J. Transcatheter treatment for systemic-to-pulmonary artery shunt obstrution in infants and children. Catheter Cardiovasc Interv 2008; 71: 928–935.Google Scholar
11. Sutherell, J, Hirsch, R, Beekman, R, et al. Pediatric interventional cardiology in the United States is dependent on the off-label use of medical devices. Congenit Heart Dis 2010; 5: 2–7.Google Scholar
12. Kogon, B, Villarj, C, Shah, N, et al. Occlusion of the modified Blalock–Taussig shunt: unique methods of treatment and review of catheter-based intervention. Congenit Heart Dis 2007; 2: 185–190.Google Scholar
13. Moszura, T, Zubrzycka, M, Michalak, K, et al. Acute and late obstrution of a modified Blalock-Taussig shunt: a two-center experience in different catheter-based methods of treatment. Interact Cardiovasc Thorac Surg 2010; 10: 727–731.Google Scholar
14. Krasemann, T, Tzifa, A, Rosenthal, E, et al. Stenting of modified and classical Blalock–Taussig shunts – lessons learned from seven consecutive cases. Cardiol Young 2011; 21: 430–435.CrossRefGoogle ScholarPubMed
15. Alwi, M, Choo, K, Kandavello, G, et al. Initial results and medium-term follow-up of stent implantation of patent ductus arteriosus in duct-dependent pulmonary circulation. J Am Coll Cardiol 2004; 44: 438–445.CrossRefGoogle ScholarPubMed
16. Miglionico, M, Patti, G, D'Ambrosio, A, et al. Percutaneous coronary intervention utilizing a new endothelial progenitor cells antibody-coated stent: a prospective single-center registry in high-risk patients. CatheterCardiovasc Interv 2008; 71: 600–604.Google Scholar
17. Aoki, J, Serruys, P, van Beusekom, H, et al. Endothelial progenitor cell capture by stents coated with antibody against CD34: the HEALING-FIM (healthy endothelial accelerated lining inhibits neointimal growth-first in man) Registry. J Am Coll Cardiol 2005; 45: 1574–1579.Google Scholar
18. Duckers, H, Soullié, T, den Heijer, P, et al. Accelerated vascular repair following percutaneous coronary intervention by capture of endothelial progenitor cells promotes regression of neointimal growth at long-term follow-up: final results of HEALING II trial using an endothelial progenitor cell capturing stent (Genous R stent®). Euro Intervention 2007; 3: 350–358.Google Scholar
19. Silber, S, Damman, P, Klomp, M, et al. Clinical results after coronary stenting with the Genous Bio-engineered R stent: 12-month outcomes of the e-HEALING (Healthy Endothelial Accelerated Lining Inhibits Neointimal Growth) worlwide registry. EuroIntervention 2011; 6: 819–825.CrossRefGoogle Scholar
20. Komatsu, R, Ueda, M, Naruko, T, et al. Neointimal tissue response at sites of coronary stenting in humans: macroscopic, histological, and immunohistochemical analyses. Circulation 1998; 98: 224–233.Google Scholar
21. McElhinney, D, Bergersen, L, Marshall, A. In situ fracture of stents implanted for relief of pulmonary arterial stenosis in patients with congenitally malformed hearts. Cardiol Young 2008; 18: 405–414.Google Scholar
22. Farb, A, Sangiorgi, G, Carter, A, et al. Pathology of acute and chronic coronary stenting in humans. Circulation 1999; 99: 44–52.Google Scholar
23. Yoder, M. Defining human endothelial progenitor cells. J Thromb Haemost 2009; 7 (Suppl 1): 49–52.Google Scholar
24. Beijk, M, Klomp, M, Verouden, N, et al. Genous® endothelial progenitor cell capturing stent vs the Taxus Liberté stent in patients with de novo coronary lesions with a high-risk of coronary restenosis: a randomized, single-centre, pilot study. Eur Heart J 2010; 31: 1055–1064.Google Scholar
25. Nakazawa, G, Granada, J, Alviar, C, et al. Anti-CD34 antibodies immobilized on the surface of sirolimus-eluting stetns enhance endothelization. J Am Coll Cardiol 2010; 3: 68–75.Google Scholar
26. Kutryk, M, Kuliszewski, M. In vivo endothelial progenitor cell seeding for the accelerated endothelization of endovascular devices. Am J Cardiol 2003; 92 (Suppl 6A): 94L–95L.Google Scholar
27. Kong, D, Melo, L, Mangi, A, et al. Enhanced inhibition of neointimal hyperplasia by genetically engineered endothelial progenitor cells. Circulation 2004; 109: 1769–1775.Google Scholar
28. Kaestner, M, Handle, R, Photiadis, J, et al. Implantaion of stents as an alternative to reoperation in neonates and infants with acute complications after surgical creation of a systemic-to-pulmonary arterial shunt. Cardiol Young 2008; 18: 1777–1784.Google Scholar
29. Zabala-Arquelles, J, Conejo-Muñoz, L, Cuenca-Peiró, V, et al. Ductal stenting for acute thrombosis off modified Blalock-Taussig shunts. Rev Esp Cardiol 2010; 63: 1212–1213.Google Scholar
30. Petit, C, Gillespie, M, Kreutzer, J, et al. Endovascular stents for relief of cyanosis in single-ventricle patients with shunt or conduit dependent pulmonary blood flow. Catheter Cardiovasc Interv 2006; 68: 280–286.Google Scholar
31. Santoro, G, Gaio, G, Castaldi, B, et al. Arterial duct stenting in low-weight newborns with duct-dependent pulmonary circulation. Catheter Cardiovasc Interv 2011; 78: 677–685.CrossRefGoogle ScholarPubMed