Short-term experience of porcine small intestinal submucosa patches in paediatric cardiovascular surgery

Abstract

Surgical reconstructions or palliations of congenital heart defects often require the utilization of patches, of which the ideal material has yet to be discovered. Recently, porcine small intestinal submucosa extracellular matrix (SIS-ECM) has been advocated as an alternative to conventional synthetic or biological patch material. Here, we present our initial experience with SIS-ECM in paediatric cardiovascular reconstructions. A retrospective review of all patients <18 years of age who had SIS-ECM implanted during surgery from July 2009 to September 2011 was performed. Chart review consisted of assessment of heart defect, operative procedures, implant location, echocardiograms, reinterventions and pathology studies related to any explanted SIS-ECM. During the study period, 37 paediatric patients had SIS-ECM implanted during a cardiovascular reconstruction. Mean length of follow-up was 411 days (range 6-757 days). SIS-ECM was implanted in 48 cardiac locations as patches for septal defects (n = 13), vascular augmentation (n = 26), outflow tract augmentation (n = 7) and valve reconstruction (n = 3). Eight of the patients required SIS-ECM patches in multiple locations. There was progressive stenosis in one RVOT patch requiring reoperation. Progressive stenosis in a near-circumferential pulmonary artery patch was present in 1 patient, requiring stent placement. All other patched structures remained patent. SIS-ECM is suitable for the closure of septal defects. Use of SIS-ECM for the reconstructions of outflow tracts and great vessels carries a small risk of stenosis, especially in patches that form the majority of the vessel circumference. The long-term follow-up is needed to determine the risk of late stenosis.