Contemporary Multicenter Outcomes for Truncus Arteriosus With Interrupted Aortic Arch

Buckley, Jason R.; Costello, John M.; Smerling, Arthur J.; Sassalos, Peter; Amula, Venugopal; Cashen, Katherine; Riley, Christine; Bakar, Adnan; Iliopoulos, Ilias; Jennings, Aimee; Narasimhulu, Sukumar Suguna; Mastropietro, Christopher W.

doi:10.1016/j.athoracsur.2022.08.040

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…Thus, neonatal repair of TA was recommended due to the risk of aggravation of pulmonary vascular obstruction with age. Patients who received TA repair achieved gradually improved early outcomes and excellent longterm survival if getting through the first year after surgery in recent decades (7,9,10). Unfortunately, due to the unbalanced medical development and distribution in developing countries, patients with TA referred to our hospital tend to be older than 1 month.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and occurrence of post-operative pulmonary hypertension crisis after late referral truncus arteriosus repair

Zhu

Jiang

Zhang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundTruncus arteriosus (TA) is a rare congenital heart disease with a high rate of early mortality. The occurrence of post-operative pulmonary hypertension crisis (PHC), known to be a common and life-threatening complication, increases due to the irreversible development of pulmonary vascular resistance with age. We sought to figure out the risk factors for PHC and describe the surgical outcomes of TA patients with late referral (repair <1 month excluded).Materials and methodsWe retrospectively reviewed patients after TA repair between 2009 and 2021 at Shanghai Children’s Medical Center. The occurrence of PHC was defined according to post-operative Pp/Ps ≥ 1 and clinical manifestations. Risk factors for PHC and mortality were conducted by multivariable analysis.ResultsA total of 98 patients were treated, including 55 males and 43 females. The median age at repair was 121 (69, 245) days. Post-operative PHC occurred in 22 (22.4%) patients with a median age of 186 (122, 293) days. By multivariable analysis, patients with the sum of Z-score of pre-operative bilateral pulmonary artery (PA) diameters (OR: 1.6, 95% CI: 1.2–2.3, P = 0.01) was more likely to experience PHC. Longer CPB duration contributed to early death (OR: 1.0, 95% CI: 1.0–1.0, P = 0.01). Total survival at 10 years was 81.4%. In 4.5 (2.9, 7.5) years of follow-up, twenty-six patients received 30 reinterventions. Valved reconstruction of RVOT most predicted reinterventions (OR: 4.2, 95% CI: 1.4–13.0, P = 0.01).ConclusionSurgical repair of TA patients with late referral has resulted in comparatively favorable early and mid-term outcomes. PHC occurred more commonly in patients with overextended bilateral PA pre-operatively. Meanwhile, valved reconstruction of RVOT would more likely lead to early reintervention.

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Section: Discussionmentioning

confidence: 99%

Outcomes and occurrence of post-operative pulmonary hypertension crisis after late referral truncus arteriosus repair

Zhu

Jiang

Zhang

et al. 2022

Front. Cardiovasc. Med.

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“…DiGeorge syndrome and a post-tracheostomy status are among the risk factors for late death. 916, 932 Pulmonary resistance remains relatively high in many patients and could be related to unfortunate results in the longer term. 116 NYHA functional class is usually I or II.…”

Section: Truncal Valve Regurgitationmentioning

confidence: 99%

“…These will be effective, although transiently. 932,938,939 b) The Truncal Valve Surgery to the truncal valve is not infrequent after repair; freedom from reoperation being 80-83% at 10 years and 62-85% at 20 years. 933,934,940 In patients in whom the valve was repaired at the initial definitive procedure, freedom from reoperation is lower: 20-40% at 10 years and 15-20% at 20 years.…”

Section: Truncal Valve Regurgitationmentioning

confidence: 99%

JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair

Ohuchi

Kawata²,

Uemura

et al. 2022

Circ J

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9JCS 2022 Guideline on Management/Re-Intervention in ACHD comorbidity, 172 and cardiac catheterization is fundamental for its evaluation. 173 ▋ 3.4.4 Left Heart Catheterization and Coronary Angiography Echocardiography, CT, and MRI are often substituted for left ventriculography, aortography, or coronary angiography. CT precisely illustrates abnormal origins and courses of the coronary arteries in many cases, which is why coronary angiography is not recommended as a routine examination (Class III). In some patients, nonetheless, coronary angiography is quite informative beyond CT resolution; for example, anastomotic stenosis at the coronary arterial origin would be better demonstrated by catheter angiography after the arterial switch procedure. 174 ▋ 3.4.5 Endomyocardial Biopsy Endomyocardial biopsy is rarely required in patients with postoperative CHD. ▋ 3.4.6 Catheter InterventionTranscatheter closure of atrial septal defect or patent ductus arteriosus is carried out routinely in the cardiac catheterization room, as is percutaneous pulmonary angioplasty. Interventional closure of ventricular septal defect needs more evidence before becoming established in Japan.Transcatheter pulmonary valve replacement will be introduced in the near future.Electrophysiological study and catheter ablation are common practices for arrhythmias in the CHD field. Recent advances in technology and devices, such as 3D mapping systems, have contributed to notable results in anti-arrythmic treatments in patients with repaired CHD. 175

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The Devil Is in the Details…

François

2023

The Annals of Thoracic Surgery

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Contemporary Multicenter Outcomes for Truncus Arteriosus With Interrupted Aortic Arch

Cited by 5 publications

References 14 publications

Outcomes and occurrence of post-operative pulmonary hypertension crisis after late referral truncus arteriosus repair

Outcomes and occurrence of post-operative pulmonary hypertension crisis after late referral truncus arteriosus repair

JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair

The Devil Is in the Details…

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