Oclusão Percutânea das Comunicações Interatriais Tipo Ostium Secundum com Próteses de Nitinol Revestidas de Última Geração

Abstract

RESUMOIntrodução: A oclusão percutânea das comunicações intera triais tipo ostium secundum com as próteses disponíveis co mercialmente é procedimento seguro e eficaz. Apresentamos a experiência com duas próteses de nova geração, com fios de nitinol revestidos. ABSTRACT Transcatheter Occlusion of Secundum Atrial Septal Defects with Latest Generation Coated Nitinol Wire DevicesBackground: Transcatheter occlusion of secundum atrial sep tal defects using commercial available devices is a safe and effective procedure. We present our experience with two new generation coated nitinol wire devices. Methods: We report device characteristics, implantation technique and outcomes of patients with atrial septal defects treated with the Lifetech CERA™ ASD Occluder and the Cocoon Septal Occluder. Results: Procedures were performed in 49 patients, 37 were female. Ages ranged from 7 to 68 years and body weight from 17 to 90 kg. The aortic rim was present in 34.7% and atrial septal aneurysms in 14.3% of the patients. Mean diameter was 13 ± 7 mm whereas the balloonstretched diameter was 22 ± 7 mm. Implantation was possible in all cases and 55 devices were used. Fortyfive CERA™ and four Cocoon devices were used. Three patients required occlusion of a second orifice. During the procedures the first device had to be replaced by a larger one in two cases, and in the third case it was replaced due to a tuliplike malformation of the left atrial disc. Immediate occlusion occurred in 91.9% and in 95.9% at 6 months. There were no deaths or other significant com plications. Conclusions: The use of both CERA™ and Cocoon devices was simple and reproducible in experienced hands. Shortterm occlusion rates were similar to the ones obtained with the Amplatzer™ device. More studies and longterm followup are required to determine the actual advantages of coated nitinol wire devices.

Relato Preliminar sobre a Concentração Sanguínea de Níquel Após Oclusão Percutânea de Comunicação Interatrial com a Prótese Cocoon®

“…In agreement with a recent publication by Chamié et al 3 regarding the two new coated nitinol mesh prostheses, about which there are few references in the literature and that have been implanted in 49 patients (Lifetech CERA TM ASD Occluder and Cocoon Septal Occluder TM ), it was observed that the handling and the functional profile of the devices used are very satisfactory. More studies and a long-term follow-up are needed to document some aspects related to the potential benefits of coated nitinol wires, which in addition to increasing the device radiopacity, facilitating its visualization and its positioning under fluoroscopy, appear, considering the results of this investigation, to promote the effects of reduced nickel release into the bloodstream and increased occluder biocompatibility.…”

“…More studies and a long-term follow-up are needed to document some aspects related to the potential benefits of coated nitinol wires, which in addition to increasing the device radiopacity, facilitating its visualization and its positioning under fluoroscopy, appear, considering the results of this investigation, to promote the effects of reduced nickel release into the bloodstream and increased occluder biocompatibility. 3…”

“…The discs of these early models, which did not have a centralization mechanism, were one of the causes of their disuse, due to the difficult repositioning and handling of the prostheses. 3 Most currently used devices consists of a nickel (55%) and titanium (45%) alloy, 4 also known as nitinol (Nickel TItanium Naval Ordnance Laboratory), developed in the 1960s by the United States Navy. 5 Nitinol has favorable physicochemical properties such as resistance to corrosion and material fatigue, thermal memory, and elasticity, which allow for the passage of large devices through small catheters, in addition to non-ferrous properties, which even allow the performance of MRI after implantation.…”

“…11 Allergy after nitinol prosthesis implantation has been rarely described, with the development of skin rash, 12 as well as other symptoms such as dyspnea, pericarditis, chest discomfort, palpitations, and migraine with or without aura. 3,4,13,14 These symptoms were more frequent in individuals that had a positive skin test reaction to nickel. 15 More alarmingly, there are cases reports in which it was decided to explants the prosthesis without accurate or proven definition of the allergic reaction.…”

“…15 In this context, latest-generation prostheses used to occlude atrial septal defects have been developed with coated nitinol wires. 3,15 Therefore, they might present a distinct pattern of nickel release into the bloodstream. The present study, which is preliminary and pioneering, aimed to study this fact.…”