Impact of Patch Materials on Reintervention and Reoperation Rates following Pulmonary Artery Reconstruction

Background: Various patch materials are currently used for pulmonary artery (PA) reconstruction in right-sided obstructive lesions. However, data on long-term durability of patch materials is sparse. Hence, we investigated four patch materials: (1) expanded polytetrafluoroethylene (ePTFE); (2) autologous pericardium (AP); (3) equine pericardium (EP); and (4) bovine pericardium (BP) and compared reintervention and reoperation rates.

Method: We reviewed all patients with right-sided obstructive lesions including tetralogy of Fallot, pulmonal atresia (with/without ventricular septal defect) and pulmonary stenosis from our electronic institutional congenital heart disease database, who underwent PA reconstruction over a period of seven years (1/2012 to 12/2018) at our institution. Exclusion criteria were redo procedures, patients age > 18 years and single-ventricle physiology.

PA reconstruction was determined as implantation of patch material to main PA (including transannular patches) or PA branches.

Study endpoint was the composite of catheter-based re-intervention or re-operation to relieve recurrent stenoses at the level of the right ventricular outflow tract, pulmonary valve, main PA or PA branches.

Results: A total of 157 patients (median age: 6 months, range: 0–86 months; median weight: 6.2 kg, range: 3.0–15.0 kg) underwent PA reconstruction with implantation of ePTFE (n = 98), EP (n = 30), AP (n = 24), or BP (n = 5). Patch sites were main PA (n = 140) and/ or PA branches (n = 25).

Over a follow-up period of 3.4 ± 2.0 years, 30 patients reached the study endpoint. Freedom from composite endpoint was 93 ± 2% and 45 ± 5% at 5 years following patch implantation at main PA and PA branches, respectively (log-rank test, p < 0.01).

Comparison of patch materials showed similar reintervention and reoperation rates between ePTFE, AP, and EP at both locations. In contrast, BP implantation at main PA was associated with a significantly inferior outcome compared with other materials (log-rank test: ePTFE vs. BP, p = 0.01 and EP vs. BP, p = 0.005).

Conclusion: Following PA patch reconstruction, reinterventions and reoperations were occasionally required, especially at the level of pulmonary artery branches. However, patch material had only a minor impact on recurrence of stenosis of main or peripheral PA. Though, usage of BP material cannot be recommended.

Publication History

Article published online:
03 February 2022