Mid-term results following pulmonary artery patch augmentation in congenital heart disease

Maria von Stumm; Tim Hildebrandt; Thibault Schaeffer; Paul Philipp Heinisch; Stanimir Georgiev; Cordula Wolf; Peter Ewert; Jürgen Hörer; Julie Cleuziou

doi:10.21037/tp-23-382

Mid-term results following pulmonary artery patch augmentation in congenital heart disease

Transl Pediatr. 2023 Nov 28;12(11):1992-2000. doi: 10.21037/tp-23-382. Epub 2023 Nov 24.

Authors

Maria von Stumm^{1

2}, Tim Hildebrandt¹, Thibault Schaeffer^{1

2}, Paul Philipp Heinisch^{1

2}, Stanimir Georgiev³, Cordula Wolf^{3

4}, Peter Ewert³, Jürgen Hörer^{1

2}, Julie Cleuziou^{1

2}

Affiliations

¹ Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, School of Medicine, Technical University of Munich, Munich, Germany.
² Division of Congenital and Paediatric Heart Surgery, University Hospital of Munich-Ludwig-Maximilian University of Munich, Munich, Germany.
³ Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany.
⁴ DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.

Abstract

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.

Keywords: Congenital pulmonary artery stenosis (congenital PAS); patch augmentation; patch plasty; pulmonary artery (PA).