Outcomes of Repair of Common Arterial Trunk With Truncal Valve Surgery: A Review of The Society of Thoracic Surgeons Congenital Heart Surgery Database

Abstract

Background Previous studies have suggested truncal valve insufficiency may adversely affect outcome after common arterial trunk (CAT) repair. It is unknown if truncal insufficiency requiring truncal valve surgery (TVS) at the time of primary CAT repair impacts outcome. Methods Patients in the STS Congenital Heart Surgery Database undergoing CAT repair from 2000–2009 were included. Outcomes were compared for those with and without TVS at the time of CAT repair and were further stratified by interrupted aortic arch (IAA) repair. Results Of 572 patients (63 centers), median age at surgery was 12d (interquartile range 6–34d). Twenty-three patients underwent concomitant TVS (n=22 repair, n=1 replacement) during CAT repair, and 4 patients underwent TVS later during the same hospitalization (n=1 repair, n=3 replacement). Thirty-nine patients underwent IAA repair at the time of CAT repair, 5 of whom had concomitant TVS. Mortality for CAT repair with TVS vs. isolated CAT repair was 30% vs.10% (p=0.0002). All 4 patients who required TVS later during the admission died. TVS was associated with increased mortality in CAT patients both with and without IAA repair, with the highest mortality (60%) in CAT patients undergoing IAA repair and TVS (n = 5). CAT + TVS had an increased risk of mechanical support and a longer hospital stay. Conclusions TVS in patients undergoing CAT repair is associated with significant mortality. IAA repair and TVS at the time of CAT repair carries particularly high risk. Failure to address significant truncal insufficiency, necessitating early reoperation with TVS, had uniformly poor outcomes.

Contemporary experience with surgical treatment of aortic valve disease in children

“…This is in contradistinction to published series of truncal valve repairs and replacements in which long-term survivals have been noted to be compromised. 14 Of the valve replacement options applied to small patients (children in whom adult-sized prostheses cannot be used), the Ross procedure appears to be the most durable. 15,16 Although not always possible owing to anatomic defects and clearly a more technically demanding procedure, several large studies including our own have shown excellent midterm and long-term results.…”

Commentary: Assessing risk factors after truncus arteriosus repair—The devil is in the details

“…Despite major improvements in the perioperative care of these patients, reported in-hospital death remains high (9%-11%). 2,3 Although the report of Mastropietro and colleagues 1 shows a slightly lower operative mortality, the limited number of experienced centers that have participated in this study may have influenced this finding. Moreover, despite the somewhat lower operative mortality risk, the study of Mastropietro and colleagues 1 still shows significant postoperative morbidity.…”

Morbidity in children and adolescents after surgical correction of truncus arteriosus communis

“…Previous studies have demonstrated hospital mortality between 5-19%(5,9,11-14,16,18,19) with the largest series from the Society for Thoracic Surgery Congenital Heart Surgery Database demonstrating an unadjusted mortality of 10%(10,14,20). Our study design does not provide peri-operative mortality data, and we cannot comment on how our cohort compares to those in previous studies in this domain.…”