Comparison of Patch Materials for Pulmonary Artery Reconstruction

Abstract

Various patch materials with variable cost are used for pulmonary artery reconstruction. An analysis of reintervention based on type of patch material might inform value-based decision making. This was a retrospective review of 214 sites of pulmonary artery reconstruction at a single center from 2000 to 2014. We excluded patients with unifocalization of aortopulmonary collaterals. Primary outcome was reintervention for each type of patch. Total number of patch sites was 214 (180 patients). Median follow-up was 3.7 years. Patch materials and number of sites were branch patch homograft (92), bovine pericardium (44), autologous pericardium (41), and porcine intestinal submucosal patch (37). Median age and weight at the time of patch reconstruction were 12.1 months and 8.5 kg. Reintervention occurred at 34 sites (15.9%). With Cox proportional hazards regression, the following variables were associated with reinterevention: preoperative renal failure - hazard ratio of 4.36 (1.87-10.16), P < 0.001 and weight at surgery - hazard ratio 0.93 (0.89-0.98), P = 0.004. Patch type was not related to reintervention (P = 0.197). Cost per unit patch ranged from $0 (dollars, US) for untreated autologous pericardium to $6,105 for homograft branch patch. In this retrospective analysis, there was no relationship between type of patch used for main or central branch pulmonary artery reconstruction and subsequent reintervention on that site. This finding, combined with the widely disparate costs of patches, may help inform value-based decision making.

Keywords: Patch; Pulmonary artery; Reconstruction; Reintervention.

Figure 1.

Graphical abstract summarizing the overall results of our study comparing reintervention for a main or central branch pulmonary artery reconstruction site and various patch materials. Autologous pericardium was associate with the lowest reintervention and was free. Multivariable analysis demonstrated lack of superiority of homograft branch patch, which clearly has a much higher cost.

Figure 2.

Kaplan-Meier freedom from reintervention for pulmonary artery reconstruction for the entire cohort of patients undergoing main or central branch pulmonary artery reconstruction. The shaded area indicates 95% confidence limits.

Figure 3.

Kaplan-Meier freedom from reintervention for pulmonary artery reconstruction comparing homograft patch to all other patches combined. The combined group included autologous pericardium, bovine pericardium, and porcine submucosal patch. There was no apparent difference between the two groups of patches. Green is the combined other group. Orange is homograft. Shaded areas indicate 95% confidence limits.

Figure 4.

Kaplan-Meier freedom from reintervention for pulmonary artery reconstruction comparing four patch types-homograft patch (aqua color, line with short and long dashes), autologous pericardium (aut pericard, purple, uniform small dots), bovine pericardium (peri bovine, green), and porcine submucosal patch (Cormatrix, red). Confidence limits are not included to avoid obscuring the curves but are provided in Supplementary Table 1. No patch appeared to have uniquely superior or inferior performance - P = 0.34.