Association between postoperative fine particulate matter exposure and right ventricle-pulmonary artery conduit patency

Background Ambient air pollution is a leading risk factor for cardiovascular diseases. No study has investigated the association between fine particulate matter (PM2.5) exposure and prognosis of patients undergoing right ventricle-pulmonary (RV-PA) artery conduit surgery. We hypothesized that PM2.5 can lead to stenosis of the conduit by stimulating inflammatory response in the conduit lumen. Methods From 2013 to 2020, patients with six complicated congenital heart defects and had undergone RV-PA operation in Beijing Fuwai Hospital were selected. Four conduit materials were used: bovine jugular vein graft (BJV), pulmonary homograft (PHG), aortic homograft (AHG), and handmade tri-leaflet expanded polytetrafluoroethylene (ePTFE) conduit. Telephone interviews were used to confirm the patients’ postoperative addresses. The monthly averages of PM2.5 concentrations were obtained from the ChinaHighPM2.5 dataset using patients’ places of residence. By comparing findings of echocardiography performed prior to patients’ return to their residence and during re-examination, we defined the trans-conduit peak velocity increase of ≥1.5 m/s as the study endpoint. Results 232 patients were included in the study. Logistic analysis identified the female gender to be a protective factor against conduit velocity increase (Odd Ratio (OR) 0.270 (95% confidential interval (CI): 0.094–0.780), P = 0.016). Compared with BJV conduits, homografts (AHGs and PHGs) (0.052 (95% CI: 0.005–0.558), P = 0.015) and ePTFE conduits (0.009 (95% CI: 0.002–0.054), P <0.001) were protective factors. The cumulative monthly PM2.5 concentration (unit 10μg/m3) was a risk factor (1.014 (95% CI: 1.001–1.026), P = 0.028). Winter experience was a risk factor (1.971 (95% CI: 1.021–3.804, P = 0.043). In the subgroup analysis, Spearman correlation analysis identified BJV conduits (r = 0.680, P <0.001), PHGs (r = 0.559, P = 0.020), AHGs (r = 0.745, P = 0.021) had medium-to-high positive correlations between the cumulative PM2.5 concentration and conduit velocity change. For ePTFE, the correlation was weak and not significant (r = 0.222, P = 0.073). Conclusion Postoperative PM2.5 exposure affects the patency of biologic prosthetic conduits, especially the xenograft. The ePTFE conduit velocity increase is not associated with PM2.5 exposure which is a suitable material for patients living in high pollutant concentration areas. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial This is a retrospective observational study ### Funding Statement This work was supported by Beijing Municipal Science and Technology Commission (No.Z141107002514002) and National Health Commission (No.2022-GSP-GG-32). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This retrospective study was conducted in compliance with the Good Clinical Practice (GCP) principle and approved by the Ethics Committee of Fuwai Hospital (ethical number: 2015-651; approved: April 22, 2015). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Anyone who wishes to share, reuse, remix, or adapt this material must obtain permission from the corresponding author.