Anatomical Site and Patch Material as Determinants of Reintervention After Pulmonary Artery Patch Arterioplasty in Congenital Heart Disease: A Systematic Review
DOI:
https://doi.org/10.46799/adv.v4i9.672Keywords:
pulmonary artery, patch arterioplasty, congenital heart disease, reintervention, patch material, branch pulmonary artery stenosis, systematic reviewAbstract
Pulmonary artery stenosis remains a significant challenge following congenital heart disease surgery, often requiring pulmonary artery patch arterioplasty and subsequent reintervention due to recurrent obstruction. Although anatomical site and patch material have been proposed as potential determinants of long-term outcomes, their independent contributions remain uncertain. This systematic review aimed to evaluate the association between anatomical site and patch material and the risk of reintervention following pulmonary artery patch arterioplasty in patients with congenital heart disease. A systematic review was conducted according to the PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched from inception through September 2026. Studies reporting reintervention outcomes after pulmonary artery patch augmentation were included. Due to heterogeneity in anatomical locations, patch materials, outcome definitions, and analytical approaches, the findings were synthesized narratively. Risk of bias was assessed using the ROBINS-I tool. Eighteen non-randomized studies involving 2,696 patients were included. Anatomical site demonstrated a consistent association with reintervention risk, with branch pulmonary artery reconstruction showing higher reintervention rates compared with main pulmonary artery reconstruction or transannular patch augmentation. Bilateral branch pulmonary artery involvement was also associated with an increased risk of reintervention. In contrast, the effects of patch material were inconsistent, with most comparative studies showing no significant differences among materials. The anatomical characteristics of pulmonary artery reconstruction appear to be stronger determinants of reintervention risk than patch material. Future multicenter studies with standardized outcome definitions and long-term follow-up are required to further clarify the potential effects of patch materials.
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