Recurrent stenosis after extracellular matrix implantation for congenital heart disease
Presenter
Danielle D Strah, MD, Rady Children's Hospital, San Diego, CA
Danielle D Strah, MD, Rady Children's Hospital, San Diego, CA, Mike D. Seckeler, M.D., FSCAI, The University of Arizona, Tucson, AZ, Katie Kowalek, MD, University of Arizona, Division of Critical Care, Department of Pediatrics, Tucson, AZ and Surbhi B Patel, BS, University of Arizona, Tucson, AZ
Keywords: Adult Congenital Heart Disease (ACHD), Complications and Congenital Heart Disease (CHD)
Background
Patients with congenital heart disease (CHD) may need multiple surgeries throughout life. Ideally, a material that is durable and grows with the patient should be used for patches, conduits and baffles. Porcine small intestinal submucosa extracellular matrix (ECM) has been used, but there is concern about sustainability in CHD.
Methods
Single institution review from 2009-2020 of patients who underwent cardiac cath after ECM implantation for various CHD. Number of caths and interventions were assessed.
Results
15 patients underwent 41 post-ECM caths to treat stenosis; demographics and clinical characteristics are in the Table. All first-line interventions were cath-based: angioplasty alone (20%), stent placement for failed angioplasty (33%) or primary stent placement (47%). 7 patients underwent 17 repeat catheterizations for recurrent stenoses, either failed angioplasty (12%) or stent distortion/in-stent restenosis (88%). 8 patients underwent subsequent surgeries, of which 5 were to intervene on ECM; 1 had recurrent stenosis and underwent an additional cath after the post-ECM surgery.
Conclusions
Although intended to be an ideal material for cardiac surgery, ECM appears to have unacceptably high rates of re-stenosis leading to repeated cath interventions and associated morbidities. Implant location does not appear to make a difference as both areas of high-velocity pulsatile flow and low-velocity venous flow developed stenosis. Even after stent placement, there is frequent in-stent stenosis, stressing the importance of close surveillance and low threshold for caths.
