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

Abstract

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.

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

“…given that the earlier era was associated with early mortality, early mortality in the current era was much better (4.5%, 1/22) which was comparable with other recent series [5,9]. Furthermore, later attrition among early survivors rarely occurred; consequently, most mortality occurred in the first postoperative year, which is similar to the findings of previous reports [11,12].…”

“…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. With progress in surgical techniques and perioperative management, outcomes have been gradually improved [5,8,9]. While various factors associated with mortality and reinterventions have been identified in previous studies, mortality, morbidity, and reinterventions after repair are still not uncommon [5][6][7][9][10][11][12].…”

“…With progress in surgical techniques and perioperative management, outcomes have been gradually improved [5,8,9]. While various factors associated with mortality and reinterventions have been identified in previous studies, mortality, morbidity, and reinterventions after repair are still not uncommon [5][6][7][9][10][11][12].…”

Adult Female Patient with Untreated Truncus Arteriosus Type I and Torsion of Small Bowel Gastrointestinal Stromal Tumor: A Rare Case Report

“…Persistent TA is rare among congenital heart lesions, accounting for approximately 2% to 4% [ 4 ]. TA features a single arterial trunk that supplies the systemic circulation, pulmonary arteries, and coronary arteries.…”

A modified approach in the repair of type I and II truncus arteriosus to promote branch pulmonary arterial growth and limit early reoperation

“…Strategies to prevent early right ventricular outflow tract (RVOT) reoperation after the repair of truncus arteriosus (TA) have focused primarily on the type or size of conduit used to establish right ventricular to pulmonary artery (PA) continuity. 1 , 2 , 3 , 4 , 5 , 6 , 7 Although the conduit type and size likely contribute to the timing of reoperation, potential distortion of the branch PAs at the time of initial repair is often overlooked. Traditionally, the branch PAs are excised from the truncal root and the corresponding defect used as the pulmonary bifurcation.…”