Abstract
Introduction: We reviewed our experience with decellularized porcine small intestine sub-mucosa (DPSIS) patch, recently introduced for congenital heart defects.Materials and Methods: Between 10/2011 and 04/2016 a DPSIS patch was used in 51 patients, median age 1.1 months (5 days to 14.5 years), for aortic arch reconstruction (45/51 = 88.2%) or aortic coarctation repair (6/51 = 11.8%). All medical records were retrospectively reviewed, with primary endpoints interventional procedure (balloon dilatation) or surgery (DPSIS patch replacement) due to patch-related complications.Results: In a median follow-up time of 1.5 ± 1.1 years (0.6–2.3years) in 13/51 patients (25.5%) a re-intervention, percutaneous interventional procedure (5/51 = 9.8%) or re-operation (8/51 = 15.7%) was required because of obstruction in the correspondence of the DPSIS patch used to enlarge the aortic arch/isthmus, with median max velocity flow at Doppler interrogation of 4.0 ± 0.51 m/s. Two patients required surgery after failed interventional cardiology. The mean interval between DPSIS patch implantation and re-intervention (percutaneous procedure or re-operation) was 6 months (1–17 months). While there were 3 hospital deaths (3/51 = 5.9%) not related to the patch implantation, no early or late mortality occurred for the subsequent procedure required for DPSIS patch interventional cardiology or surgery. The median max velocity flow at Doppler interrogation through the aortic arch/isthmus for the patients who did not require interventional procedure or surgery was 1.7 ± 0.57 m/s.Conclusions: High incidence of re-interventions with DPSIS patch for aortic arch and/or coarctation forced us to use alternative materials (homografts and decellularized gluteraldehyde preserved bovine pericardial matrix).
Highlights
We reviewed our experience with decellularized porcine small intestine sub-mucosa (DPSIS) patch, recently introduced for congenital heart defects
Aortic coarctation is quite frequently associated with aortic arch hypoplasia, requiring attention at the time of surgery
The criteria generally agreed to define the presence of aortic arch hypoplasia are: (a) aortic arch size mm < body weight kg + 1; (b) aortic arch diameter z-score < −2.0; (c) ratio of transverse arch diameter to descending aorta
Summary
We reviewed our experience with decellularized porcine small intestine sub-mucosa (DPSIS) patch, recently introduced for congenital heart defects. The approach with cardiopulmonary bypass through median sternotomy, necessary when associated heart malformations require surgical treatment in the same session, can be accomplished with various techniques of aortic arch reconstruction with or without the use of a patch enlargement. After experimental [6,7,8] and clinical [9,10,11] studies, the decellularized porcine small intestine sub-mucosa (DPSIS) patch has been introduced with the commercial name of CorMatrix R (CorMatrix Cardiovascular, Roswell, GA) for the surgical treatment of congenital heart defects, with implantations performed for closure of septal defects, valve repair, and as vascular patch in both the systemic and pulmonary circulations [12,13,14,15,16]
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