Novel technique for transcatheter closure of sinus venosus atrial septal defect: The temporary suture‐holding technique

Abstract

Background: Transcatheter repair of sinus venosus atrial septal defect (SVASD) has become an alternative option to surgical repair. There are potential significant complications related to stent stability in the superior vena cava (SVC) and potential migration of the stent that need to be addressed. Therefore, the technique is still evolving.Objectives: To report results of a new modification "the suture technique" that improves safety profile of positioning and securing a covered stent in the SVC.Methods: This is a descriptive, single center, retrospective review of patients who underwent SVASD closure using the suture technique at our institution between 02/2020 and 08/2022.Results: Fourteen patients underwent transcatheter repair of SVASD using the suture technique. All procedures were successful. The suture technique allowed precise stent placement in all patients without any migration or complication. Six patients required additional stent placement at the level of the SVC. One patient had an additional covered stent placed to eliminate a tiny residual shunt. Two patients had negligible residual shunts at the time of the procedure. At follow-up, all patients clinically improved and had significant reduction in right heart size on echocardiography and/or magnetic resonance imaging. No arrhythmia was reported in any patient. None required re-intervention after a mean follow-up of 16.5 ± SD 10.5 months. Conclusions:The suture technique appears to be safe modification. Although our study involves small sample size with no comparative group, we believe our technique offers greater control over stent positioning, reducing the risk of stent embolization and residual shunting in transcatheter closure of SVASD.

Outcomes Following Surgical Repair of Sinus Venosus Atrial Septal Defects: A Systematic Review and Meta‐Analysis

“…After abstract screening, 36 full‐text articles were evaluated, leading to the inclusion of 12 papers detailing transcatheter repairs involving ≥2 patients with SVASD. 2 , 3 , 4 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 There is a possibility that a few of these publications were derived from the same patient cohort. We made a deliberate decision against consolidating these findings into the overall systematic review to avoid double counting patients.…”

“…A comprehensive summary of the outcomes stemming from this analysis is provided in Table S3 . 2 , 3 , 4 , 50 , 51 , 52 , 53 , 54 , 55 , 56 The majority of studies reported data on adult patients, with 9 of 12 studies having a study population aged>18 years. The Cheatham‐platinum stent was the most commonly used implant.…”

Innominate vein occlusion by the fabric of covered stent during transcatheter closure of sinus venosus defects – Causes, management, and outcome

“…Two different methods suggested to avoid caudal stent migration and embolization include using an anchoring stitch for the upper end of the covered stent from jugular vein access or suturing two stents together before deployment. [ 9 ] An anchor zone of at least 2 cm in the SVC is essential for the stability of the covered stent. [ 5 6 ]…”

Percutaneous closure of a superior sinus venosus atrial septal defect with partial pulmonary anomalous venous drainage: An option also for children

“…The selection of the appropriate one (long stents, overlapping stents, temporary suture-holding technique, etc.) should depend on the individual clinical situation and the experience of the center [4].…”