Consensus document on optimal management of patients with common arterial trunk

Hazekamp, Mark G.; Barron, David J.; Dangel, Joanna; Homfray, Tessa; Jongbloed, Monique R.M.; Voges, Inga

doi:10.1093/ejcts/ezaa423

Cited by 9 publications

(15 citation statements)

References 207 publications

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“…In some centers, autologous tissue has been preferred for establishing RV-PA continuity to reduce the risk of RV-PA reintervention [5]; however, RV-PA reintervention might not be inevitable, since non-autologous materials such as homografts, jugular vein valved conduits, prosthetic conduits with bioprosthetic valves, and prosthetic valved conduits have been the predominant choices of material for establishing RV-PA continuity at most centers. Although a pulmonary homograft might have the greatest durability, followed by an aortic homograft, these methods were not easily available in Korea during the study period; moreover, there is a lack of conclusive evidence regarding the superiority of homografts in longevity compared to the other types of conduits [4]. In our study, the 5 patients who underwent the REV procedure did not show superior outcomes regarding freedom from RVOT reintervention.…”

Section: Jcsmentioning

confidence: 65%

“…With respect to mortality outcomes, a point that should be mentioned regarding our surgical strategy is that we have been open to a staged option for patients having conditions not suitable for long surgery using cardiopulmonary bypass. Although early total repair is known to be a prevalent strategy for TA repair [4], staged repair is performed at some centers with comparable outcomes [8]. Significant TrV dysfunction was defined as truncal stenosis or regurgitation greater than mild.…”

Section: Jcsmentioning

confidence: 99%

“…In TA, a single truncal artery arises from the heart through a single truncal valve (TrV), where both aorta and pulmonary arteries originate. Other types of cardiovascular anomalies, including ventricular septal defect, TrV abnormalities, arch obstruction, and coronary artery anomalies, are frequently associated with TA [3,4]. At most centers, TA is repaired within the first few weeks of life [4][5][6][7], unless pulmonary obstructive disease, which is always life-threatening, could develop [4].…”

Section: Introductionmentioning

confidence: 99%

“…Other types of cardiovascular anomalies, including ventricular septal defect, TrV abnormalities, arch obstruction, and coronary artery anomalies, are frequently associated with TA [3,4]. At most centers, TA is repaired within the first few weeks of life [4][5][6][7], unless pulmonary obstructive disease, which is always life-threatening, could develop [4]. Although a staged approach has been adopted to avoid significant morbidity and mortality following neonatal surgery [8], early 1-stage repair has been a standard approach for this anomaly.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Surgical Repair for Truncus Arteriosus: A 30-Year Single-Center Experience

et al. 2023

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Background:We investigated the long-term outcomes of truncus arteriosus repair at a single institution with a 30-year study period. Methods: Patients who underwent repair of truncus arteriosus between 1993 and 2022 were reviewed retrospectively. Factors associated with early mortality, overall attrition, and reintervention were identified using appropriate statistical methods. Results: In total, 42 patients were enrolled in this study. The median age and weight at repair were 26 days and 3.5 kg, respectively. Thirty patients (71.4%) underwent 1-stage repair. There were 8 early deaths (19%). In the univariable analysis, undergoing surgery before 2011 was associated with early mortality (p=0.031). The overall survival rate at 10 years was 73.8%. In the multivariable analysis, significant truncal valve (TrV) dysfunction (p=0.010), longer cardiopulmonary bypass time (p=0.018), and the earlier era of surgery (p=0.004) were identified as risk factors for overall mortality. During follow-up, 47 reinterventions were required in 27 patients (64.3%). The freedom from all-cause reintervention rate at 10 years was 23.6%. In the multivariable analysis, associated arch obstruction (p<0.001) and significant TrV dysfunction (p=0.011) were identified as risk factors for all-cause reintervention. Arch obstruction (p=0.027) and a number of TrV cusps other than 3 (p=0.014) were identified as risk factors for right ventricle to pulmonary artery (RV-PA) reintervention, and significant TrV dysfunction was identified as a risk factor for TrV reintervention (p=0.002). Conclusion: Despite recent improvements in survival outcomes after repair of truncus arteriosus, RV-PA or TrV reinterventions were required in a significant number of patients during follow-up.

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Section: Jcsmentioning

confidence: 65%

Section: Jcsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes of Surgical Repair for Truncus Arteriosus: A 30-Year Single-Center Experience

et al. 2023

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“…Some authors prefer pulmonary artery banding (PAB) as an initial palliative strategy, analogous to the hybrid approach of bilateral PAB in the setting of hypoplastic left heart syndrome. Although this approach is challenging in small patients [ 17 , 18 ], the placement of PAB as an initial palliative strategy may be beneficial and even life-saving in high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Repair of common arterial trunk: palliation and delayed correction as a viable alternative strategy in selected patients

Cuomo

Purbojo

Blumauer

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Primary repair of common arterial trunk (CAT) is burdened by high mortality rates, especially in the presence of multiple risk factors. Timing, possible palliative methods, optimal management of associated cardiac lesions and handling of a poor preoperative state are still under discussion. METHODS We retrospectively analysed all patients who underwent surgery for CAT in our institution between 2008 and November 2020. We included 22 patients, 11 of whom received primary correction (PC) and 11 of whom underwent initial palliation by partial repair, leaving the ventricular septal defect open and connecting the right ventricle to the pulmonary arteries with a small valveless right ventricle-to-pulmonary artery conduit. A delayed correction (DC) was performed after 11.5 ± 3.6 months. RESULTS The overall operative mortality was 4.5%; 1 patient (affected by severe truncal valve stenosis and presenting in a poor state preoperatively) in the DC group died after palliation. The incidence of postoperative pulmonary hypertensive crisis was significantly higher in the PC group (P = 0.027). No patient from either group required postoperative extracorporeal support. Survival rates after 6 years differed slightly (PC group, 90%; DC group, 70%; log-rank = 0.270). CONCLUSIONS PC of CAT remains an optimal surgical approach for patients with an expected low mortality. However, our data support palliation and DC as a suitable alternative strategy, especially in the presence of significant risk factors like interrupted aortic arch, poor preoperative condition or complex surgical anatomy.

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Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies

Crago

Winlaw

Farajikhah

et al. 2023

Bioengineering & Transla Med

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Congenital heart diseases (CHDs) frequently impact the right ventricular outflow tract, resulting in a significant incidence of pulmonary valve replacement in the pediatric population. While contemporary pediatric pulmonary valve replacements (PPVRs) allow satisfactory patient survival, their biocompatibility and durability remain suboptimal and repeat operations are commonplace, especially for very young patients. This places enormous physical, financial, and psychological burdens on patients and their parents, highlighting an urgent clinical need for better PPVRs. An important reason for the clinical failure of PPVRs is biofouling, which instigates various adverse biological responses such as thrombosis and infection, promoting research into various antifouling chemistries that may find utility in PPVR materials. Another significant contributor is the inevitability of somatic growth in pediatric patients, causing structural discrepancies between the patient and PPVR, stimulating the development of various growthaccommodating heart valve prototypes. This review offers an interdisciplinary perspective on these challenges by exploring clinical experiences, physiological understandings, and bioengineering technologies that may contribute to device development. It thus aims to provide an insight into the design requirements of next-generation PPVRs to advance clinical outcomes and promote patient quality of life.

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Consensus document on optimal management of patients with common arterial trunk

Cited by 9 publications

References 207 publications

Outcomes of Surgical Repair for Truncus Arteriosus: A 30-Year Single-Center Experience

Outcomes of Surgical Repair for Truncus Arteriosus: A 30-Year Single-Center Experience

Repair of common arterial trunk: palliation and delayed correction as a viable alternative strategy in selected patients

Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies

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