Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience

Abstract

ObjectiveThis study aimed to report our experiences with surgical repair in patients of all ages with persistent truncus arteriosus.MethodsFrom July 2004 to July 2014, 50 consecutive patients with persistent truncus arteriosus who underwent anatomical repair were included in the retrospective review. Median follow-up time was 3.4 years (range, 3 months to 10 years).ResultsFifty patients underwent anatomical repair at a median age of 19.6 months (range, 20 days to 19.1 years). Thirty patients (60%) were older than one year. The preoperative pulmonary vascular resistance and mean pulmonary artery pressure were 4.1±2.1 (range, 0.1 to 8.9) units.m2 and 64.3±17.9 (range, 38 to 101) mmHg, respectively. Significant truncal valve regurgitation was presented in 14 (28%) patients. Hospital death occurred in 3 patients, two due to pulmonary hypertensive crisis and the other due to pneumonia. Three late deaths occurred at 3, 4 and 11 months after surgery. The actuarial survival rates were 87.7% and 87.7% at 1 year and 5 years, respectively. Multivariate analysis identified significant preoperative truncal valve regurgitation was a risk factor for overall mortality (odds ratio, 7.584; 95%CI: 1.335–43.092; p = 0.022). Two patients required reoperation of truncal valve replacement. One patient underwent reintervention for conduit replacement. Freedom from reoperation at 5 years was 92.9%. At latest examination, there was one patient with moderate-to-severe truncal valve regurgitation and four with moderate. Three patients had residual pulmonary artery hypertension. All survivors were in New York Heart Association class I-II.ConclusionsComplete repair of persistent truncus arteriosus can be achieved with a relatively low mortality and acceptable early- and mid-term results, even in cases with late presentation. Significant preoperative truncal valve regurgitation remains a risk factor for overall mortality. The long-term outcomes warrant further follow-up.

Multicenter Analysis of Early Childhood Outcomes After Repair of Truncus Arteriosus

“…In our cohort 14 of the 201 hospital survivors died in the follow-up period. Importantly, most of these deaths (71%) occurred within the first year after operation, a finding that is mirrored by several singlecenter studies examining outcomes after surgical repair of truncus arteriosus [1,2,4,10,12,15].…”

“…(Ann Thorac Surg 2019;107:553-9) Ó 2019 by The Society of Thoracic Surgeons T runcus arteriosus is an uncommon, complex cardiac anomaly that continues to be associated with significant morbidity and mortality beyond the initial surgical repair. In single-center studies with follow-up periods ranging from 2 to 24 years, mortality beyond the initial surgical hospitalization has been reported to be 2% to 15%, whereas reintervention on the right ventricle-topulmonary artery (RV-PA) conduit later in life is nearly universal and the major source of long-term morbidity [1][2][3][4][5][6][7][8][9][10][11][12]. Although these single-center studies have provided valuable contributions to the literature, they are confounded by center-specific surgical and perioperative management strategies, small sample sizes, and data that span different surgical eras To our knowledge no multicenter data examining intermediate or long-term outcomes after surgical repair of truncus arteriosus have been published.…”

Peer Review #1 of "Long-term outcomes of repaired and unrepaired truncus arteriosus: 20-year, single-center experience in Thailand (v0.1)"

“…All of these patients survived postoperatively and remained in follow-up until the end of study with a median duration of 5.6 years (range: 4.1-12.7 years). These findings suggest that repair of TA in patients who are older than one year of age is feasible, though physicians need to deliberately select the cases (16,17).…”

Late management of truncus arteriosus: 20 years of humanitarian experience

“…The immediate prognosis of the surgery depends on the crisis of pulmonary arterial hypertension, which can require a extended stay in the recovery room, but which evolves generally favourably thanks to the new pulmonary arterial hypertension management, inhaled NO, relayed by sildenafil: only 1 death out of 33 in our series. At 1 year, global mortality in the operated on population is low at 2/33 (6%) when it is greater when surgery is performed earlier in the infancy: 11% between 2005 and 2014 in the series of Naimo et al 16 and 12% in that of Chen et al 17 The mid-and long-term prognosis of operated common arterial trunk remains marked by the need for another operation either on the truncal valve, or on the pulmonary conduit. 18 In our series, with a mean follow-up of 3.4 years (up to 16 years), we have not had as yet to operate again on the truncal valve, with a good stability of the aortic insufficiency in timeeven if several teams mention good performances after additional operation for severe aortic insufficiency.…”