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Mid-term results following pulmonary artery patch augmentation in congenital heart disease
Maria von Stumm1,2, Tim Hildebrandt1, Thibault Schaeffer1,2
1Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, School of Medicine, Technical University of Munich, Munich, Germany.
Insights
Surgical patch augmentation for pulmonary artery stenosis in congenital heart disease showed similar re-intervention rates for most materials, but bovine pericardium had worse outcomes. Patching PA branches, not the main PA, increased re-intervention risk.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Pulmonary artery (PA) stenosis in congenital heart disease (CHD) is linked to poor outcomes.
- Surgical patch augmentation is a common treatment for PA stenosis.
- Comparing outcomes of different patch materials is crucial for improving patient care.
Purpose of the Study:
- To compare the outcomes of surgical patch augmentation for PA stenosis in biventricular CHD using various patch materials.
- To identify factors associated with re-intervention after PA stenosis repair.
Main Methods:
- Retrospective cohort study of 156 patients undergoing PA stenosis patch augmentation (2012-2018).
- Patch materials included autologous pericardium (AP), expanded polytetrafluoroethylene (ePTFE), equine pericardium (EP), and bovine pericardium (BP).
- Primary endpoint: re-intervention or re-operation for recurrent stenosis; analyzed factors including patch material, location (main PA vs. branches), and patient weight.
Main Results:
- Over 4 years follow-up, 19% of patients required re-intervention.
- Freedom from re-intervention was significantly lower for PA branch augmentations (25%) compared to main PA (92%).
- Bovine pericardium (BP) showed significantly higher re-intervention rates compared to ePTFE and EP; no significant differences between ePTFE, AP, and EP.
Conclusions:
- Patch augmentation of the main PA is associated with acceptable outcomes.
- Patch augmentation of PA branches is an independent risk factor for re-intervention.
- While no material showed superiority, bovine pericardium was associated with inferior outcomes and increased re-intervention rates.
Background:
Treatment of pulmonary artery (PA) stenosis in congenital heart disease is associated with adverse outcomes. The aim of this retrospective cohort study was to compare outcomes after surgical patch augmentation of PA stenosis in patients with biventricular congenital heart disease using different patch materials.
Methods:
We identified all patients from our institutional congenital heart disease database who underwent patch augmentation for PA stenosis on the main pulmonary artery (MPA) or PA branches between 2012 and 2018. Patch materials used were glutaraldehyde fixated autologous pericardium (AP), expanded polytetrafluoroethylene (ePTFE), equine pericardium (EP), and bovine pericardium (BP). The primary study endpoint was the composite of catheter-based re-intervention or re-operation to relieve recurrent stenosis at the site of prior implanted patch material.
Results:
A total of 156 patients (median age, 5 months, range, 0-85 months; median weight, 6.2 kg, range, 2.8-15.0 kg) underwent patch augmentation using 163 patches (ePTFE =99, 61%; EP =34, 21%; AP =25, 15%; BP =5, 3%). Overall, 131 (84%) patients underwent patch augmentation at the MPA, and 25 (16%) patients underwent patch augmentation at one or both PA branches. Over a mean follow-up period of 4±2 years, 30 patients (19%) reached the study endpoint. Freedom from primary endpoint was 92%±3% for the MPA and 25%±9% for PA branches at 5 years, respectively (P<0.001). Comparison of patch materials revealed similar re-intervention rates between ePTFE, AP, and EP. In contrast, outcomes were significantly decreased following the usage of BP when compared to other materials (ePTFE vs. BP, P=0.01; EP vs. BP, P=0.005). In the multivariable analysis, lower weight at index operation, patch augmentation of PA branches, and usage of BP were independently associated with re-intervention.
Conclusions:
Patch augmentation of the MPA was associated with acceptable outcomes, while patch augmentation of PA branch stenosis remained independently associated with re-intervention. None of the used patch materials demonstrated superiority; however, BP had a higher rate of re-interventions.
