Biodegradable stents and occluders in CHD: current evidence, biomechanical constraints, and translational challenges

Abstract

Congenital heart disease (CHD) often requires device implantation during childhood, when somatic growth and changing haemodynamics place particular demands on permanent implants. Metallic stents and nitinol occluders are effective, but their lifelong persistence can complicate repeat interventions, limit imaging surveillance, and interfere with growth-related remodelling. This review examines the rationale, current evidence, biomechanical constraints, and translational challenges of biodegradable stents and occluders in CHD. These devices aim to provide temporary mechanical support followed by controlled resorption, thereby reducing the burden of permanent foreign material and preserving future interventional options. Translation to congenital practice is, however, not straightforward, as early structural integrity must be balanced against predictable degradation, adequate endothelialisation, and compatibility with somatic growth. Experience from adult coronary bioresorbable scaffolds cannot be directly extrapolated to paediatric anatomies or timelines. Biodegradable septal occluders have accumulated more clinical experience and appear closer to routine use, whereas biodegradable vascular stents remain largely investigational and lack sufficient long-term outcome data to support broader adoption. Further long-term studies in paediatric and congenital populations are needed before biodegradable implants can be recommended as standard alternatives to permanent devices in CHD.