Covered Stent Correction for Sinus Venosus Atrial Septal Defects, an Emerging Alternative to Surgical Repair: Results of an International Registry
Authors: Rosenthal Eric , Qureshi Shakeel A. , Sivakumar Kothandam , Jones Matthew , Yong San-Fui , Kabir Saleha , Sagar Pramod , Thejaswi Puthiyedath , Hascoet Sebastien , Batteux Clement , Boudjemline Younes , Hijazi Ziyad M. , Aboulhosn Jamil A. , Levi Daniel S. , Salem Morris M. , Francis Edwin , Kempny Aleksander , Fraisse Alain , Bautista-Rodriguez Carles , Walsh Kevin , Kenny Damien , Traynor Brian , Al Maskari Salim N. , Bentham James R. , Környei László , Sivaprakasam Muthukumaran C. , Firouzi Ata , Khajali Zahra , Benson Lee , Osten Mark , Baruteau Alban-Elouen , Crystal Matthew A. , Forbes Thomas J. , Georgiev Stanimir , Sievert Horst , Tin Do Nguyen , Springmuller Daniel , Subramanian Anand , Abdullah Hussein A.M. , Bedair Radwa , Chamié Francisco , Celebi Ahmet , Damsky Barbosa Jesus , De Meester Pieter , Giugno Luca , Jalal Zakaria , Karsenty Clement , Schleiger Anastasia , Fleming Gregory , Jakob Andre , Karagoaz Tevfik , Mainzer Gur , Morgan Gareth J. , Narin Nazmi , Shahanavaz Shabana , Steinberg Zachary L. , Aldoss Osamah , Alizade Elnur , Aregullin Oliver , Bouvaist Hélène , Fleck Thilo , Godart Francois , Malekzadeh-Milani Sophie , Motta Paulo , Sanchez-Recalde Angel , Sandoval Juan Pablo , Tan Weiyi , Thomson John , Tome Pablo , Zahn Evan M. 
Published: December 2024

BACKGROUND:
Covered stent correction for a sinus venosus atrial septal defect (SVASD) was first performed in 2009. This innovative approach was initially viewed as experimental and was reserved for highly selected patients with unusual anatomic variants. In 2016, increasing numbers of procedures began to be performed, and in several centers, it is now offered as a standard of care option alongside surgical repair. However, covered stent correction for SVASD is not recognized by regulatory authorities, and in the minds of many pediatric and adult congenital cardiologists and surgeons, the condition is viewed as treatable only by cardiac surgery with cardiopulmonary bypass.

METHODS:
In April 2023, all centers identified from international conferences, publications, and colleague networks to be undertaking covered stent correction for SVASD were invited to participate in a retrospective audit of their procedures.

RESULTS:
Data were received on 381 patients from 54 units over a 12-year period with 90% of procedures being performed over the past 5 years. Balloon-expandable stents (8 types) were used in the majority; self-expanding stents (4 types) were used in 4.5%. The commonest stent was the 10-zig covered Cheatham Platinum stent in 62% of cases. In 10 procedures, the stent embolized requiring surgical retrieval and repair of the defect, resulting in technically successful implantation in 371 of 381 (97.4%). Major complications (surgical drainage of tamponade, pacemaker implantation, surgery for pulmonary vein occlusion, and late stent removal) occurred in 5 patients (1.3%). Repeat catheterization to correct residual leaks was required in 7 patients (1.8%). Thus, 359 of 381 patients (94.2%) had successful correction without major complications or additional catheter interventions.

CONCLUSIONS:
This article details the exponential uptake of covered stent correction for SVASD during the past 5 years. Cardiopulmonary bypass was avoided in the majority of patients, and major complications were infrequent. Prospective registries with standardized definitions, inclusion criteria, and follow-up and comparative studies with surgery are now required to help support the extension of covered stent correction as an alternative standard-of-care option for patients with an SVASD.