Late management of truncus arteriosus: 20 years of humanitarian experience

Gouton, Marielle; Lucet, V.; Bical, O; Leca, F

doi:10.1017/s1047951117002050

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…30% of patients had significant post-operative pulmonary hypertension with one early mortality (3%) and one late mortality (3%) 6 months post-repair. 18 In our study, 16 patients with late truncus arteriosus presentation underwent surgery at mean age of 5 months, 11(69%) of patients had significant pulmonary hypertension while no patients died within 30 days post-surgery. However, late mortality happened in 25% of patients due to unresolved pulmonary hypertension.…”

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confidence: 59%

Outcome of truncus arteriosus repair: 20 years of single-center experience comparing early versus late surgical repair

et al. 2021

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Background: Truncus arteriosus is a rare CHD. Neonatal and early infancy repair is recommended though some cases may present late. The aim of our study is to investigate the current results of truncus arteriosus repair and to analyse the differences in outcome and reintervention need between early versus late truncus arteriosus surgical repair. Material and methods: In this cohort study, we reviewed all children who underwent truncus arteriosus repair from 2001 till 2021. We divided patients into two groups; early repair group including patients repaired at age less than 3 months and late repair group including patients who had repair at 3 months of age and later. We compared both groups for outcome variables. Results: Sixty-four children had truncus arteriosus repair including 48(75%) patients in early repair and 16(25%) patients in late repair groups. Peri-operative course was comparable between both groups. Post-surgery, we observed pulmonary hypertension in 6(12%) patients in early repair group comparing with 11(69%) patients in late repair group (p = 0.0001). In the last follow-up visit, pulmonary hypertension resolved in all early repair group patients while 6(37.5%) patients in late repair group continued to have pulmonary hypertension (p = 0.0001). Twenty-three(36%) patients required reintervention including 22(48%) in early repair group versus 1(6%) in late repair group (p = 0.007). Conclusion: In general, the outcome of early truncus arteriosus repair is excellent with resolution of pulmonary hypertension following early repair. Late repair caries higher risk of persistent pulmonary hypertension (37.5%). About one-third of the patients who had truncus arteriosus repair will require re-intervention within 38±38.4 months after initial surgery.

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confidence: 59%

Outcome of truncus arteriosus repair: 20 years of single-center experience comparing early versus late surgical repair

et al. 2021

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“…In total, 34 articles were assigned to more than one category [ 10–43 ]. The most common category was short-term surgical trip [ 13 , 18 , 20 , 25–50 ] (29 articles, 46%) followed by NGO partnership [ 10 , 11 , 13 , 19–24 , 26–30 , 32–34 , 36–43 , 51–53 ] (28 articles, 44%). Within the short-term surgical trip category, trips ranged from three days to three months, with ten days and two weeks being the most common lengths.…”

Section: Resultsmentioning

confidence: 99%

“…For these articles, post-op follow-up and patient outcomes were deemed not applicable [ 10 , 11 , 13 , 14 , 16 , 45 , 54–56 , 60 , 61 , 64 , 66–68 ]. In the remaining 48 articles, 21 (45%) included post-op follow-up care [ 12 , 15 , 17 , 18 , 20–23 , 27 , 30 , 32 , 33 , 35 , 41 , 42 , 44 , 49 , 53 , 58 , 70 , 71 ] and 31 (66%) included post-op patient outcomes [ 15 , 17 , 18 , 20–23 , 27 , 28 , 30–36 , 39 , 41 , 42 , 44 , 46 , 49 , 51–53 , 58 , 59 , 65 , 69–71 ]. The most reported outcomes were mortality (22/31 articles, 71%) and post-op complications (17/31 articles, 55%) (for a list of outcomes reported, see Table A4 ).…”

Section: Resultsmentioning

confidence: 99%

International pediatric surgery partnerships in sub-Saharan Africa: a scoping literature review

Woods

Shofner

Hodge

2022

Global Health Action

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Background Sub-Saharan Africa (SSA) faces a critical shortage of pediatric surgical providers. International partnerships can play an important role in pediatric surgical capacity building but must be ethical and sustainable. Objective The purpose of this study is to perform a scoping literature review of international pediatric surgery partnerships in SSA from 2009 to 2019. We aim to categorize and critically assess past partnerships to aid in future capacity-building efforts. Methods We performed a scoping literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. We searched the PubMed and Embase databases for articles published from 2009 to 2019 using 24 keywords. Articles were selected according to inclusion criteria and assessed by two readers. Descriptive analyses of the data collected were conducted in Excel. Results A total of 2376 articles were identified. After duplicates were removed, 405 articles were screened. In total, 83 articles were assessed for eligibility, and 62 were included in the review. The most common partnership category was short-term surgical trip (28 articles, 45%). A total of 35 articles (56%) included education of host country providers as part of the partnership. Only 45% of partnerships included follow-up care, and 50% included postoperative outcomes when applicable. Conclusions To increase sustainability, more partnerships must include education of local health-care providers, and short-term surgical trips must be integrated into long-term partnerships. More partnerships need to report postoperative outcomes and ensure follow-up care. Educating peri-operative providers, training general surgeons in common pediatric procedures, and increasing telehealth use are other goals for future partnerships.

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“…A prior report, describing the outcomes of late referred truncus arteriosus patients, indicated significant pulmonary hypertension requiring specific treatment in 30% of patients (at a mean of three years of age at referral). 12 The same report also suggested that a preoperative oxygen saturation of at least 88% was favorable for complete repair. Pediatric cardiac centers in the developed world typically have the resources to diagnose and manage these patients.…”

Section: Commentmentioning

confidence: 92%

Single Institution Experience With International Referrals for Pediatric Cardiac Surgery

Rebolledo

Kumar²,

Tansey

et al. 2020

World J Pediatr Congenit Heart Surg

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Background: Pediatric cardiac surgery in developing countries poses many challenges. The practice of referring patients from abroad via nongovernmental organizations has occurred for many years. We describe our experience with international referrals for pediatric cardiac surgery via Gift of Life Mid-South to the Heart Institute, Le Bonheur Children’s Hospital in Memphis, Tennessee. Methods: We performed a retrospective descriptive review of data collected in our Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) along with data from our electronic medical record from January 1, 2007, to December 31, 2017. Available data included patient demographics, diagnoses, surgical procedure, entire inpatient length of stay (LOS), complications, and operative mortality. Cardiac surgeries were grouped according to the Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Categories (STAT Mortality Categories). Complications were defined according to the STS CHSD. Results: In this retrospective descriptive study, case complexity level varied; however, 38% cardiac surgeries were in STAT Mortality Category 3 or 4. Honduras was the most common referral source with a total of 18 countries represented. Operative mortality remained very low (1 [1.4%] of 71 cardiac surgeries) despite patients being referred beyond infancy. There were an increasing number of complications and longer inpatient LOS (with greater variance) in STAT Mortality Category 4. Conclusions: International patients referred for congenital heart surgery can be successfully treated with an acceptable mortality rate despite late referrals. Inpatient LOS is related to surgical complexity. Follow-up studies are needed to determine the long-term outcomes of these patients.

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Late management of truncus arteriosus: 20 years of humanitarian experience

Abstract: Late management and surgery of common arterial trunk is possible with good long-term results without prior hemodynamic examination up to an advanced childhood when signs of left-to-right shunt persist. A high saturation level (above 88%) seems to be a good operability criterion.

Cited by 7 publications

References 20 publications

Outcome of truncus arteriosus repair: 20 years of single-center experience comparing early versus late surgical repair

Outcome of truncus arteriosus repair: 20 years of single-center experience comparing early versus late surgical repair

International pediatric surgery partnerships in sub-Saharan Africa: a scoping literature review

Single Institution Experience With International Referrals for Pediatric Cardiac Surgery

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