Percutaneous Catheter Interventions via Glidesheath Slender in Small Children

Objectives: In small children, the diameter of the vessels comprises a significant limitation for catheter interventions. Arterial occlusion after cardiac catheterization is a serious complication with variable clinical manifestations. The objective of this study is to evaluate the clinical safety and efficacy of the Glidesheath Slender in small children.

Methods: We report on a group of 53 small patients (median age: 117 days [min. 3; max. 1,302], median weight: 5.1 kg [min. 1.4; max. 14.0]) in whom percutaneous interventions (n = 56) were performed via Glidesheath Slender. Types of intervention: stent implantation (re-CoA n = 11, PDA n = 7, LPA n = 4, Sano shunt n = 1, Blalock–Taussig shunt n = 2, AP shunt n = 1, RPA n = 2, FO n = 1, RVOT n = 1); occlusion (VSD n = 7, collateral vessels n = 4, PDA n = 2, scimitar artery n = 1); balloon dilatation (LPA n = 2, PDA stent n = 2, re-CoA n = 2, LPA stent n = 1, re-CoA stent n = 2, PV n = 1, stent in the common pulmonary vein in patient with TAPVR n = 1); and Rashkind procedure (n = 1). In 50 children, the intervention was performed from femoral access (artery n = 36, vein n = 14) in 2 from the subclavian arterial access and in 1 from the jugular venous access. The 5F (n = 45) and 6F (n = 8) Glidesheath Slender sheaths were used in our study group. In all patients, the vessel access was obtained under ultrasound guidance.

Results: None of the patients presented symptoms of vessel narrowing or occlusion (median follow-up time: 99 days [min. 1; max. 608]). After the catheterization, the pulse on the peripheral arteries (posterior tibial artery or radial artery) was palpable in all patients. No clinical signs of vein occlusion were noticed in patients in whom the intervention was performed from the venous site.

Conclusion: The Glidesheath Slender enables to perform various types of interventions with 1F-less outer sheath diameter. We expect that the risk of vessel scarring and occluding is lower with this approach. The initial experience with this sheath in obtaining radial access in adults is promising. Our study proves that performing percutaneous interventions via Glidesheath Slender in small children is safe and feasible, and extends percutaneous treatment possibilities in the field of pediatric cardiology.

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