Heart stent
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Summary
10 papers analyzed
These studies suggest that stents are effective in treating various heart conditions, including congenital heart disease and ischemic heart disease, with advancements in materials and technology improving outcomes and reducing complications.
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Heart Stents: Efficacy, Safety, and Future Directions
Introduction to Heart Stents
Heart stents are small mesh tubes inserted into narrowed or blocked coronary arteries to keep them open and ensure adequate blood flow. They are crucial in treating various heart conditions, including congenital heart disease (CHD) and ischemic heart disease (IHD). This article synthesizes recent research on the use of heart stents, focusing on their efficacy, safety, and future developments.
Stents in Congenital Heart Disease (CHD)
Efficacy and Safety of Stents in CHD
Balloon-expandable stents have been effectively used to treat CHD, particularly in cases where surgical intervention is challenging. Studies have shown that these stents significantly reduce pressure gradients in patients with branch pulmonary artery stenosis and other postoperative stenoses . For instance, in one study, stents reduced pressure gradients from 50.6 mm Hg to 15.9 mm Hg in pulmonary artery stenosis cases. Another study reported similar success, with pressure gradients in pulmonary arteries dropping from 55.2 mm Hg to 14.2 mm Hg post-stent placement.
Intermediate-Term Follow-Up
Intermediate-term follow-up studies indicate that stents maintain their efficacy over time. In a cohort of 85 patients, stents showed no significant change in luminal diameter or pressure gradient upon recatheterization, suggesting sustained benefits. However, complications such as stent migration and restenosis were noted, albeit infrequently .
Covered Stents in CHD
Covered stents, such as the Cheatham-Platinum stents, have shown promise in treating complex congenital cardiovascular malformations. These stents effectively reduce pressure gradients and increase vessel diameter without significant complications, making them a valuable tool in managing CHD.
Stents in Ischemic Heart Disease (IHD)
Comparison with Other Treatments
Coronary artery stents are widely used in treating IHD, including stable and unstable angina and acute myocardial infarction (AMI). Systematic reviews have demonstrated that stents are more effective than percutaneous transluminal coronary angioplasty (PTCA) alone in preventing adverse events and reducing the need for repeat revascularizations . However, in cases of multi-vessel disease, coronary artery bypass graft (CABG) surgery may offer better long-term outcomes despite higher initial costs and risks.
Drug-Eluting Stents (DES)
Drug-eluting stents (DES) have been developed to reduce restenosis rates further. Studies indicate that DES are more effective than bare-metal stents in reducing revascularization rates, although they do not significantly impact mortality rates within the first year. The long-term cost-effectiveness of DES remains a topic of ongoing research, with some studies suggesting that their higher costs may not always justify the marginal benefits in single-vessel disease.
Advances in Stent Materials
Evolution of Metallic Stents
The evolution of stent materials has seen a transition from stainless steel to bioresorbable metals like magnesium (Mg) and zinc (Zn). While Mg-based stents have shown mixed clinical outcomes due to rapid degradation and late restenosis, Zn-based stents are emerging as promising alternatives due to their suitable degradation rates and better biocompatibility.
3D-Printed Polymer Stents
Innovations in 3D printing technology have led to the development of self-expandable polymer stents with biodegradation capacity. These stents are designed to match the mechanical performance of conventional nitinol stents and offer potential benefits for minimally invasive heart valve implantation, particularly in pediatric patients.
Conclusion
Heart stents play a critical role in managing both congenital and ischemic heart diseases. While traditional metallic stents have proven effective, ongoing research and technological advancements are paving the way for improved materials and designs. Future developments, including bioresorbable metals and 3D-printed polymer stents, hold promise for enhancing the efficacy and safety of stent-based treatments. Continued research and long-term clinical studies are essential to fully realize the potential of these innovations.
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