Transcatheter correction of sinus venosus defects (SVD) using covered Cheatham-Platinum stents (NuMED, Hopkington, New York) has emerged as an alternative to open-heart surgery. The 50- and 60-mm-long stents subsequently received CE marking and FDA approval. The anatomical configuration of SVD often requires a stent longer than 60mm. The Optimus XXL stent (AndraTec GmbH, Koblenz, Germany) is a non-premounted, balloon-expandable, cobalt-chrome, extra-large stent, with a covered 99-mm-long version specifically developed for SVD correction, as recently reported in one case.

We aim to describe initial experience of transcatheter SVD closure with Optimus stents.

We report an international multicentre case-serie of 6 cases achieved in three centres between November 2021 and March 2022 in adults aged 26- to 72-years-old (IRB00012157).

High opening of the anomalous pulmonary venous return (APVR) in the superior vena cava (SVC) was identified in 4 cases. A venous femoro-jugular rail was used. Transseptal access to establish an APVR pathway was used in 5 cases, with balloon inflation simultaneously to Optimus stent deployment in 4. In 2 cases, a single size (outer/inner balloon of 30/24mm diameter and 100mm length) Gemini balloon-in-balloon was used to implant the stent. The maximal diameter of this balloon was larger than the SVC diameter. In 4 cases, the single size 100mm length Gemini balloon was not chosen given a too large diameter and other 20 to 30mm shorter balloon-in-balloon were used, with an outer balloon diameter between 18 to 22mm to match the diameter of the SVC. Such setting required additional inflations of the extremities of the stent that were not fully expanded by those smaller balloons. A second uncovered stent was implanted at the upper part of the stent in 3 cases to provide additional anchoring to the SVC. In 4 cases, we achieved technical and clinical success as in Fig. 1. One procedure was marked by PV obstruction reversed by PV balloon dilation but leading to residual shunting. One of the 4 cases, where a shorter balloon-in-balloon was used, was complicated by migration of the stent in the right atrium. The stent was subsequently pushed-up and anchored in the SVC using another uncovered stent.

The Optimus covered, 99 mm-long, Optimus XXL stent allows successful transcatheter SVD. Further experience and a wider range of stent/balloons are needed.