Heart Care Info - Heart Disease Prevention & Treatment

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

HM Russell, SK Pasquali, JP Jacobs... - The Annals of Thoracic ..., 2011 - Elsevier 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. ...

Of 572 patients (63 centers), median age at surgery was 12 days (interquartile range, 6 to 34). 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 versus isolated CAT repair was 30% versus 10% (p = 0.0002). All 4 patients who required TVS later during the admission died. Truncal valve surgery was associated with increased mortality among CAT patients both with and without IAA repair, with the highest mortality (60%) among CAT patients undergoing IAA repair and TVS (n = 5). Common arterial trunk plus TVS had an increased risk of mechanical support and a longer hospital stay.

Truncal valve surgery in patients undergoing CAT repair is associated with significant mortality. Repair of IAA 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.