Abstract
Objective
To determine the outcomes of patients with a quadricuspid truncal valve (TV) and durability
of TV repair.
Method
We reviewed 56 patients with truncus arteriosus and a quadricuspid TV who underwent
complete repair between 1979 and 2018.
Results
TV insufficiency was present in 39 patients (mild, n = 22; moderate, n = 14; and severe,
n = 3). Fourteen patients had concomitant TV surgery. Early mortality in patients
who had concomitant TV surgery was 14% (2 out of 14 patients) and overall survival
was 77.1% ± 11.7% at 15 years. Freedom from TV reoperation was 30.3% ± 14.6% at 15 years.
Early mortality in patients who did not undergo concomitant TV surgery was 9.5% (4
out of 42 patients) and overall survival was 74.9% ± 6.9% at 15 years. Progression
of TV insufficiency requiring TV surgery occurred in 16.7% (7 out of 42 patients).
Freedom from TV reoperation was 77.1% ± 7.8% at 15 years. The most common method of
repair was tricuspidization of the TV. Freedom from TV reoperation was 64.3% ± 21.0%
at 10 years after tricuspidization and 0% at 6 years after other types of TV surgery.
Overall follow-up was 97.6% (41 out of 42 patients) complete for survivors with median
follow-up of 16.6 years. At last follow-up there was no TV insufficiency in 16 patients,
mild insufficiency in 24 patients, and moderate insufficiency in 1 patient.
Conclusions
More than one-third of patients with a quadricuspid TV require TV surgery. Tricuspidization
of the quadricuspid TV appears to be a durable repair option with good long-term outcomes.
Key Words
Abbreviations and Acronyms:
TTE (transthoracic echocardiogram), TV (truncal valve)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 01, 2020
Accepted:
January 1,
2020
Received in revised form:
December 13,
2019
Received:
August 21,
2019
Footnotes
Dr Naimo is supported by a National Health and Medical Research Council Medical Research Postgraduate Scholarship and an Australian Government Research Training Program Scholarship (No. 1150242). Dr Fricke is supported by a National Health and Medical Research Council Postgraduate Scholarship and an Australian Government Research Training Program Scholarship (No. 1134203). Dr Lee is supported by a National Health and Medical Research Council Medical Research Postgraduate Scholarship and an Australian Government Research Training Program (No. 1134274). Dr d'Udekem is a practitioner fellow of the National Health and Medical Research Council of Australia (No. 1082186).
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary: Truncal root remodeling: A useful technique that can be translated to other lesions?The Journal of Thoracic and Cardiovascular SurgeryVol. 161Issue 2
- PreviewNaimo and colleagues1 present their review of patients with truncal root dysfunction who underwent truncal root remodeling. The main finding of the study is that tricuspidization-type reconstruction in quadricuspid dysfunctional valves yielded the best result over the long term. Dysfunctional aortic roots are something we are faced with more and more in the setting of congenital heart surgery; for example, dysfunctional truncal roots truncus arteriosus, dilated neoaortic root in arterial switch operations, and dilated aortic roots in conotruncal abnormalities.
- Full-Text
- Preview
- Commentary: This looks like a great hammer…which nails should we pound?The Journal of Thoracic and Cardiovascular SurgeryVol. 161Issue 2
- PreviewNaimo and colleagues from the Royal Children's Hospital in Melbourne, Australia,1 revisit their series of truncus arteriosus patients dating back to 1979.2,3 In this third installment, they focus on the management of patients with a quadricuspid truncal valve (TV) with particular attention to the technique of tricuspidization of the valve in the setting of significant TV regurgitation. The study population included 56 patients with quadricuspid valves who underwent repair between 1979 and 2018, 14 of whom underwent concomitant TV repair or replacement at the time of the initial truncus arteriosus repair.
- Full-Text
- Preview
