Evaluation and comparison of patch materials used for pulmonary arterioplasty in pediatric congenital heart surgery
Lewis, Michael J. LU
; Malm, Torsten
LU
; Hallbergson, Anna
; Ramgren, Jens Johansson
LU
and Liuba, Petru
LU
(2023)
In JTCVS Open
15.
p.424-432
- Abstract
Objective: To evaluate the long-term performance of the patch materials we have used to augment the pulmonary arterial tree across a wide spectrum of diagnoses and anatomical locations. Methods: Retrospective, single-center review of 217 consecutive pediatric patients at a tertiary referral center from 1993 to 2020 who underwent patch arterioplasty of the pulmonary arterial tree from the pulmonary bifurcation to the distal pulmonary arterial branches. Reintervention data were collected and analyzed. Lesion-specific anatomy and other variables were analyzed as risk factors for reintervention. Results: There were 280 total operations performed (217 initial operations and 63 reoperations) and 313 patches used. The patches used were... (More)
Objective: To evaluate the long-term performance of the patch materials we have used to augment the pulmonary arterial tree across a wide spectrum of diagnoses and anatomical locations. Methods: Retrospective, single-center review of 217 consecutive pediatric patients at a tertiary referral center from 1993 to 2020 who underwent patch arterioplasty of the pulmonary arterial tree from the pulmonary bifurcation to the distal pulmonary arterial branches. Reintervention data were collected and analyzed. Lesion-specific anatomy and other variables were analyzed as risk factors for reintervention. Results: There were 280 total operations performed (217 initial operations and 63 reoperations) and 313 patches used. The patches used were autologous pericardium (166, 53.0%), pulmonary homograft (126, 40.3%), and a heterogeneous group of other materials (21, 6.7%). Overall patient survival was 86.2%, freedom from reoperation was 81.0% and freedom from reintervention (FFR) was 70.6%, with a median follow-up of 13.8 years (interquartile range, 6.3-17.9 years). For all patches, 10-, 20-, and 27-year FFR was 76.6%, 70.6%, and 70.6%, respectively. FFR was similar among all 3 patch type groups (P = .29). Multivariable Cox regression analysis showed that diagnoses of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries and hypoplastic left heart syndrome, patches placed at initial cardiac operation, and increasing number of cardiac operations were risk factors for reintervention. Conclusions: Autologous pericardium and pulmonary homograft patches performed similarly. Although patch type conferred no difference in need for reintervention, other risk factors did exist. Namely, diagnoses of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries and hypoplastic left heart syndrome, patch placement at a patient's first cardiac operation, and increasing number of cardiac operations were risk factors for reintervention.
(Less)
- author
- Lewis, Michael J.
LU
; Malm, Torsten
LU
; Hallbergson, Anna
; Ramgren, Jens Johansson
LU
and Liuba, Petru
LU
- organization
- publishing date
- 2023-09
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- arterioplasty homograft, autologous pericardium, patch, pulmonary
- in
- JTCVS Open
- volume
- 15
- pages
- 424 - 432
- publisher
- Elsevier
- external identifiers
-
- scopus:85162904845
- pmid:37808011
- ISSN
- 2666-2736
- DOI
- 10.1016/j.xjon.2023.05.007
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2023 The Author(s)
- id
- 8e58fb38-9086-484f-8858-eb5b11759299
- date added to LUP
- 2024-07-13 09:35:37
- date last changed
- 2024-07-15 15:18:55
@article{8e58fb38-9086-484f-8858-eb5b11759299,
abstract = {{<p>Objective: To evaluate the long-term performance of the patch materials we have used to augment the pulmonary arterial tree across a wide spectrum of diagnoses and anatomical locations. Methods: Retrospective, single-center review of 217 consecutive pediatric patients at a tertiary referral center from 1993 to 2020 who underwent patch arterioplasty of the pulmonary arterial tree from the pulmonary bifurcation to the distal pulmonary arterial branches. Reintervention data were collected and analyzed. Lesion-specific anatomy and other variables were analyzed as risk factors for reintervention. Results: There were 280 total operations performed (217 initial operations and 63 reoperations) and 313 patches used. The patches used were autologous pericardium (166, 53.0%), pulmonary homograft (126, 40.3%), and a heterogeneous group of other materials (21, 6.7%). Overall patient survival was 86.2%, freedom from reoperation was 81.0% and freedom from reintervention (FFR) was 70.6%, with a median follow-up of 13.8 years (interquartile range, 6.3-17.9 years). For all patches, 10-, 20-, and 27-year FFR was 76.6%, 70.6%, and 70.6%, respectively. FFR was similar among all 3 patch type groups (P = .29). Multivariable Cox regression analysis showed that diagnoses of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries and hypoplastic left heart syndrome, patches placed at initial cardiac operation, and increasing number of cardiac operations were risk factors for reintervention. Conclusions: Autologous pericardium and pulmonary homograft patches performed similarly. Although patch type conferred no difference in need for reintervention, other risk factors did exist. Namely, diagnoses of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries and hypoplastic left heart syndrome, patch placement at a patient's first cardiac operation, and increasing number of cardiac operations were risk factors for reintervention.</p>}},
author = {{Lewis, Michael J. and Malm, Torsten and Hallbergson, Anna and Ramgren, Jens Johansson and Liuba, Petru}},
issn = {{2666-2736}},
keywords = {{arterioplasty homograft; autologous pericardium; patch; pulmonary}},
language = {{eng}},
pages = {{424--432}},
publisher = {{Elsevier}},
series = {{JTCVS Open}},
title = {{Evaluation and comparison of patch materials used for pulmonary arterioplasty in pediatric congenital heart surgery}},
url = {{http://dx.doi.org/10.1016/j.xjon.2023.05.007}},
doi = {{10.1016/j.xjon.2023.05.007}},
volume = {{15}},
year = {{2023}},
}