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The Peca Exgraft: Broad Applicability With Realistic Expectations For Sustained Dilation
Seth E. M. Wolf, MD, MS, Samuel Jump, MD, Annirudh Balachandran, MD, Lindsey M. Reynolds, BS, Rebekah R. Boyd, MD, Neel K. Prabhu, MD, Danielle R. Pitchon, MD, Akosua D. Odei, MD, Gregory A. Fleming, MD, Douglas M. Overbey, MD, MPH, Joseph W. Turek, MD, PhD, MBA.
Duke University Medical Center, Durham, NC, USA.
Objective: The PECA exGraft is a radially expandable ePTFE conduit permitting percutaneous balloon dilation after surgical implantation. We present the first institutional case series, focusing on dilation outcomes.Methods: A retrospective review identified 20 consecutive patients receiving the PECA exGraft (2022-2025). Post-operative and latest follow-up echocardiographic graft diameters and angiographic pre/post-dilation diameters were recorded by application type. Results: Applications included extracardiac fenestrated Fontan (n=6), mBTT shunt (n=6), PA band (n=4), PA/aortic reconstruction (n=3), and LAVV annulus cuff (n=1). Median follow-up was 202 days from implant to latest echocardiogram; among patients who underwent catheterization, this occurred at a median of 99 days from implant with latest follow-up echo obtained a median of 74 days thereafter. Nine patients underwent balloon dilation, achieving acute diameter gains (median 0.6mm, range 0.2-3.6mm). Graft diameter trajectories varied by application type: Fontan conduits, mBTT shunts, and other applications (PA/aortic reconstruction, LAVV annulus cuff) demonstrated net narrowing at latest follow-up (median −0.5mm, −0.2mm, and −0.7mm, respectively), while PA bands showed net diameter gain (median +1.4mm). These figures include patients who underwent balloon dilation in the interim period (Table 1). Conclusions: PECA exGraft use was feasible across diverse congenital heart disease applications, with balloon dilation achieving acute diameter gains. However, sustained dilation was inconsistent, as most application types demonstrated net narrowing at follow-up despite interim dilation, underscoring the need to optimize expansion strategies.
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