Comparison of Extracellular Matrix Patch and Standard Patch Material in the Pulmonary Arteries.
After pulmonary artery (PA) patch augmentation, surgical or catheterization reintervention to address PA stenosis is not uncommon. Multiple patch materials are available and the need for reintervention may be related to characteristics of the patch material. In this retrospective chart review of patients who underwent PA augmentation from 2004 through 2013, we compare outcomes after PA augmentation with standard patch (SP) material and extracellular matrix (ECM) patch material. The primary outcome was reintervention-free survival (surgery or catheterization) using Kaplan-Meier survival analysis with the log-rank test. Risk factors for reintervention were assessed with Cox proportional hazard analyses. Baseline characteristics between groups were similar, except single-ventricle (SV) patients were more likely to have SP, and duration of follow-up was longer in the SP group. Median time to reintervention for all patients was 1099 days (95 % CI 646-1552 days). There was no difference in reintervention-free survival between the patch groups (p = 0.12); however, in multivariable analysis controlling for surgeon and patch, longer reintervention-free survival was associated with SV physiology (HR 0.57 95 % CI 0.34-0.95, p = 0.03) and aortic cross-clamp (XC) use (HR 0.52, 95 % CI 0.32-0.84, p = 0.008). Since there is no difference in median time to reintervention following PA augmentation with SP or ECM, patch choice should be determined by other factors, such as surgeon preference and cost. Longer reintervention-free survival in SV patients may be related to the set schedule of staged palliation. XC use may allow more extensive PA augmentation, thus protecting against the need for reintervention.
Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, 3959 Broadway, Room 255, New York, NY, 10032, USA.
Hannah
H
Y Fraint
Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, 3959 Broadway, Room 255, New York, NY, 10032, USA.
Marc
M
E Richmond
Division of Cardiac, Thoracic and Vascular Surgery, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, 3959 Broadway, Room 274, New York, NY, 10032, USA.
Emile
E
A Bacha
Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, 3959 Broadway, Room 255, New York, NY, 10032, USA. met2148@cumc.columbia.edu.
Mariel E
ME
Turner
D002404:Catheterization; D016208:Databases, Factual; D005109:Extracellular Matrix / Q000637:transplantation*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D009519:New York City; D011651:Pulmonary Artery / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D000071079:Stenosis, Pulmonary Artery / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome
Catheterization; Congenital heart defects; Extracellular matrix; Pulmonary artery stenosis; Surgery