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

Maria von Stumm from the Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, School of Medicine, Technical University of Munich, Munich, Germany published today a new report on mid-term results following pulmonary artery patch augmentation in congenital heart disease. The results achieved with the Auto Tissue Berlin Matrix Patch equine are very positive.

von Stumm, M, T Hildebrandt, T Schaeffer, PP Heinisch, S Georgiev, C Wolf, P Ewert, J Hörer, and J Cleuziou. 2023. Mid-Term Results Following Pulmonary Artery Patch Augmentation in Congenital Heart Disease. Transl Pediatr 12 (11):1992–2000.

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.

Key findings

Patch augmentation of the main pulmonary artery (MPA) was associated with acceptable outcomes, while patch augmentation of pulmonary artery (PA) branches remained independently associated with re-intervention. Neonates and young infants aged below 4 months and weighing under 5.2 kg at index procedure showed an increased risk for re-intervention.

What is known and what is new?

Recurrence or persistence of pulmonary artery stenosis following surgical patch augmentation is a known complication.

This retrospective single-center study aims to analyse the impact of patch site (MPA, PA branches) and patch material (expanded polytetrafluoroethylene, autologous pericardium, equine pericardium, bovine pericardium) on outcomes following surgical patch augmentation.

What is the implication, and what should change now?

All four investigated patch materials were associated with re-interventions, and the ideal patch material has yet to be clarified. Therefore, frequent monitoring and a high suspicion for recurrent stenosis are indicated, especially in neonates and young infants.