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.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
03 February 2022