Decellularized vs Non-decellularized Allogeneic Pulmonary Artery Patches for Pulmonary Arterioplasty

      We studied pulmonary artery size, reinterventions, and panel reactive antibodies in patients with single-ventricle physiology who underwent a pulmonary arterioplasty with decellularized (DAPAP) and non-decellularized allogeneic pulmonary artery patches (non-DAPAP). Retrospective review identified 59 patients with single-ventricle physiology who underwent pulmonary arterioplasty from 2008 to 2017: 28 patients underwent arterioplasty with DAPAP and 31 patients with non-DAPAP. Demographic and operative variables were similar between groups. Among patients who underwent a Norwood procedure, a right ventricle to pulmonary artery shunt was more commonly used in the DAPAP group (12/20, 60%) and a modified Blalock-Taussig shunt was more commonly used in the non-DAPAP group (17/22, 77%). On multivariable analysis, the use of DAPAP was associated with higher pre-Fontan angiography Z-scores in right (estimate = 0.17, standard error = 0.04, P = 0.0005) and left pulmonary arteries (estimate = 0.12, standard error = 0.05, P = 0.01). No areas of calcification, discrete coarctation, or pulmonary dilation were noted in any of the pulmonary arteries. On multivariable analysis, the use of DAPAP was associated with higher freedom from pulmonary artery reinterventions (Hazard ratio = 0.36, 95% confidence interval = 0.13-0.9, P = 0.04). The median value for Class I panel reactive antibodies was 0% (IQR 0, 4) in the DAPAP and 23% (IQR 14, 36) in the non-DAPAP group. The median value for Class II panel reactive antibodies was 15% (IQR 0, 17) in the DAPAP and 21% (IQR 10, 22) in the non-DAPAP group. Pulmonary arterioplasty with DAPAP was associated with higher pre-Fontan pulmonary artery Z-scores and higher freedom from pulmonary artery reinterventions.

      Graphical abstract



      DAPAP (Decellularized allogeneic pulmonary artery patches), Non-DAPAP (Non-decellularized allogeneic pulmonary artery patches)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Seminars in Thoracic and Cardiovascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cresalia NM
        • Armstrong AK
        • Romano JC
        • et al.
        Long-term outcomes after surgical pulmonary arterioplasty and risk factors for reintervention.
        Ann Thorac Surg. 2018; 105: 622-628
        • Cleveland JD
        • Tran S
        • Takao C
        • et al.
        Need for pulmonary arterioplasty during Glenn independently predicts inferior surgical outcome.
        Ann Thorac Surg. 2018; 106: 156-164
        • Wilder TJ
        • Van Arsdell GS
        • Pham-Hung E
        • et al.
        Aggressive patch augmentation may reduce growth potential of Hypoplastic branch pulmonary arteries after tetralogy of fallot repair.
        Ann Thorac Surg. 2016; 101: 996-1004
        • Juaneda I
        • Peirone A
        • Diaz J
        • et al.
        Repair of the left pulmonary artery after bilateral banding in hybrid procedures: Results using “Sutureless” repair technique.
        World J Pediatr Congenit Heart Surg. 2016; 7: 89-92
        • Collins RT
        • Mainwaring RD
        • MacMillen KL
        • et al.
        Outcomes of pulmonary artery reconstruction in williams syndrome.
        Ann Thorac Surg. 2019; 108: 146-153
        • Lofland GK
        • O'Brien JE
        • Gandy KL
        • et al.
        Initial pediatric cardiac experience with decellularized allograft patches.
        Ann Thorac Surg. 2012; 93: 968-971
        • Fraint HY
        • Richmond ME
        • Bacha EA
        • et al.
        Comparison of extracellular matrix patch and standard patch material in the pulmonary arteries.
        Pediatr Cardiol. 2016; 37: 1162-1168
        • Fujita S
        • Yamagishi M
        • Kanda K
        • et al.
        Histology and mechanics of in vivo tissue-engineered vascular graft for children.
        Ann Thorac Surg. 2020; 110: 1050-1054
        • Ebert N
        • McGinnis M
        • Johnson W
        • et al.
        Comparison of patch materials for pulmonary artery reconstruction.
        Semin Thorac Cardiovasc Surg. 2021; 33: 459-465
        • Hopkins RA
        • Jones AL
        • Wolfinbarger L
        • et al.
        Decellularization reduces calcification while improving both durability and 1-year functional results of pulmonary homograft valves in juvenile sheep.
        J Thorac Cardiovasc Surg. 2009; 137: 907-913.e4
        • Hoshiba T
        • Lu H
        • Kawazoe N
        • et al.
        Decellularized matrices for tissue engineering.
        Expert Opin Biol Ther. 2010; 10: 1717-1728
        • Hawkins JA
        • Hillman ND
        • Lambert LM
        • et al.
        Immunogenicity of decellularized cryopreserved allografts in pediatric cardiac surgery: comparison with standard cryopreserved allografts.
        J Thorac Cardiovasc Surg. 2003; 126: 247-252
        • Hopkins RA
        • Lofland GK
        • Marshall J
        • et al.
        Pulmonary arterioplasty with cecellularized allogeneic patches.
        Ann Thorac Surg. 2014; 97: 1407-1412
        • Rahkonen O
        • Chaturvedi RR
        • Benson L
        • et al.
        Pulmonary artery stenosis in hybrid single-ventricle palliation: High incidence of left pulmonary artery intervention.
        J Thorac Cardiovasc Surg. 2015; 149: 1102-1110.e2
        • Pruetz JD
        • Badran S
        • Dorey F
        • et al.
        Differential branch pulmonary artery growth after the Norwood procedure with right ventricle–pulmonary artery conduit versus modified Blalock–Taussig shunt in hypoplastic left heart syndrome.
        J Thorac Cardiovasc Surg. 2009; 137: 1342-1348
        • Griselli M
        • McGuirk SP
        • Ofoe V
        • et al.
        Fate of pulmonary arteries following Norwood Procedure.
        Eur J Cardiothorac Surg. 2006; 30: 930-935
        • Pacifico AD
        • Kirklin JW
        • Blackstone EH
        Surgical management of pulmonary stenosis in tetralogy of Fallot.
        J Thorac Cardiovasc Surg. 1977; 74: 382-395
        • Nakata S
        • Imai Y
        • Takanashi Y
        • et al.
        A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart diseases with decreased pulmonary blood flow.
        J Thorac Cardiovasc Surg. 1984; 88: 610-619
        • Itatani K
        • Miyaji K
        • Nakahata Y
        • et al.
        The lower limit of the pulmonary artery index for the extracardiac Fontan circulation.
        J Thorac Cardiovasc Surg. 2011; 142: 127-135
        • Pettersen MD
        • Du W
        • Skeens ME
        • et al.
        Regression equations for calculation of Z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: An echocardiographic study.
        J Am Soc Echocardiogr. 2008; 21: 922-934
        • Hawkins JA
        • Breinholt JP
        • Lambert LM
        • et al.
        Class I and class II anti-hla antibodies after implantation of cryopreserved allograft material in pediatric patients.
        J Thorac Cardiovasc Surg. 2000; 119: 324-330
        • Spigel ZA
        • Kalustian AB
        • Binsalamah ZM
        • et al.
        Recurrent pulmonary artery interventions following the Norwood procedure are not associated with conduit type.
        Semin Thorac Cardiovasc Surg. 2021; 33: 195-201
        • Ohye RG
        • Sleeper LA
        • Mahony L
        • et al.
        Comparison of shunt types in the Norwood procedure for single-ventricle lesions.
        N Engl J Med. 2010; 362: 1980-1992
        • Gist KM
        • Barrett CS
        • Graham DA
        • et al.
        Pulmonary artery interventions after Norwood procedure: Does type or position of shunt predict need for intervention?.
        J Thorac Cardiovasc Surg. 2013; 145: 1485-1492

      Linked Article

      • Commentary: Bigger is Not Always Better
        Seminars in Thoracic and Cardiovascular Surgery
        • Preview
          In Decellularized versus Non-decellularized Allogeneic Pulmonary Artery Patches for Pulmonary Arterioplasty Bonilla-Ramirez et al. investigate the differential effect of decellularized (DAPAP) and cryopreserved pulmonary allograft (non-DAPAP) on pulmonary artery remodeling following Glenn.1 The authors show that DAPAP is associated with higher pulmonary artery z-score and lower need for reintervention. Their results suggest improved short and long-term outcomes, which they attribute to the theoretical reconstitution of the DAPAP patch, more physiological growth, and lower immunogenicity in a patient population who uniformly face transplantation.
        • Full-Text
        • PDF