Single-centre 20-year experience with repair of truncus arteriosus

Ivanov, Yaroslav; Mykychak, Yaroslav; Fedevych, Oleg; Мотречко, О. О.; Kurkevych, Andrii; Yemets, Illya

doi:10.1093/icvts/ivz007

Cited by 16 publications

(21 citation statements)

References 25 publications

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“…The number of truncal valve and interrupted arch repairs in our study was only five, which may have been too small a sample size to demonstrate a statistic difference in the multivariate analysis. The reports of late death (9.6%) were consistent with several other previous studies (14,15,18,20).…”

Section: Discussionsupporting

confidence: 92%

“…This decrease was greater than that recently reported for experienced centers (8,9,14,15,17,19), but comparable to the 2016 publication from Asagai and colleagues who reviewed 52 patients with repaired TA between 1974 and 2002 (18). The plausible explanation may be because both Asagai's (18) and ours report had mostly included patients who were beyond the neonatal period.…”

Section: Discussionsupporting

confidence: 72%

“…Elective repair during the first three months of age is historically advocated in many centers (12,13), though the benefits from repairing TA in the neonatal period is widely accepted (6,7,11,14). In this decade, the median age at the time of anatomical correction of TA has decreased significantly in many medical centers and has favorably affected surgical outcomes (14,15). In developing countries; however, delaying the referral often leads to delaying the operation, which remains a health care issue.…”

Section: Discussionmentioning

confidence: 99%

“…A number of single-center and multicenter studies have recently reported acceptable operative outcomes for patients with TA. In-hospital mortality varied from 5 to 17.5% (6,9,14,15,18,19), and the presence of associated cardiac anomalies, such as interrupted aortic arch, significant truncal valve regurgitation, coronary abnormalities, and pulmonary arteries were reported to increase the operative mortality (6)(7)(8)14). In a large cohort of patients with STS-CHSD, complex TA (defined as TA with significant aortic arch anomaly, interruption or coarctation, and truncal valve regurgitation requiring concomitant repair) accounted for 10% of the TA population, carrying an operative mortality of 30%, which is much higher than that of simple TA repair (6.9-11%) (8,9).…”

Section: Discussionmentioning

confidence: 99%

“…Drawbacks have been reported such as possible unfavorable biocompatibility resulting in pseudomembrane formation, aneurysm, and thrombosis and its poor longevity (22). The direct anastomosis technique without extracardiac conduit was proposed by Barbero-Marcial (23), and it may overcome the limited growth of conduit and decrease the need for reintervention (24), though progressive pulmonary regurgitation, postoperative pulmonary branch stenosis, and compression to the left anterior descending artery, especially in patients with coronary abnormalities, remain as significant issues (13,15). In our medical center, homografts were used in 15 patients (28%) and heterografts were used in 36 patients (69%).…”

Section: Discussionmentioning

confidence: 99%

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

2020

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Background: Truncus arteriosus (TA) is a complex congenital heart disease that carries morbidities in the first year of life. Previous authors have reported an operative mortality of 50%. In this report, we aim to report on the survival of patients with TA in our medical center in the recent era. Methods: A retrospective review of all patients diagnosed with TA in Siriraj Hospital, Thailand from August 1995 to March 2018 was performed. Patients with single ventricle, hemiTA were excluded. The characteristics and outcomes of repaired and unrepaired TA patients with a known recent functional status in 2018 were reviewed. Operative mortality risks were analyzed using a multivariate model. Results: A total of 74 patients (median age at referral: 70 days) were included in the cohort. One-third of the patients had associated anomalies including DiGeorge syndrome (13.5%). Anatomical repair was not performed in 22 patients (29.7%). The median age at time of repair for the 52 patients was 133 days (range: 22 days to 16.7 years). Complex TA was 10%. Early mortality occurred in 16 patients (30.8%). Five patients (9.6%) had late deaths at 0.3-1.2 years. Significant mortality risk was weight at time of operation < 4 kg (HR 3.05, 95% CI 1.05-8.74, p-value 0.041). Of the 31 operation survivors, 17 required re-intervention within 0.4-11.4 years. Eight patients had reoperation at 8.7 years (range: 2.7-14.6 years) post-repair. Freedom from reoperation was 93%, 70.4%, and 31%, at 5, 10, and 15 years, respectively. All late survivors were in functional class I-II. Of the 22 unrepaired TA patients, 11 patients (50%) died (median age: 13.6 years; range: 14 days-32.8 years). Survival of unrepaired TA patients was 68.2%, 68.2%, and 56.8, at 5, 10, and 15 years of age, respectively. At the end of study, 11 survivors of TA with palliative treatment had a recent mean oxygen saturation value of 84.1 ± 4.8% and a mean weight for height of 81.4 ± 12.7%, which were significantly lower than those of 31 late-survivors who had undergone anatomical repair. Conclusion: Contemporary survival rates of patients with TA following operation in the center has been gradually improved over time. Most of the operative mortality occurs in the early postoperative period. Compared to patients with TA who had palliative treatment, operative survivors have a better functional status even though they carry a risk for re-intervention.

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Section: Discussionsupporting

confidence: 92%