Advertisement

The quadricuspid truncal valve: Surgical management and outcomes

  • Phillip S. Naimo
    Affiliations
    Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia

    Department of Paediatrics, University of Melbourne, Melbourne, Australia

    Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
    Search for articles by this author
  • Tyson A. Fricke
    Affiliations
    Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia

    Department of Paediatrics, University of Melbourne, Melbourne, Australia

    Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
    Search for articles by this author
  • Melissa G.Y. Lee
    Affiliations
    Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia

    Department of Paediatrics, University of Melbourne, Melbourne, Australia

    Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
    Search for articles by this author
  • Yves d'Udekem
    Affiliations
    Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia

    Department of Paediatrics, University of Melbourne, Melbourne, Australia

    Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia

    Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
    Search for articles by this author
  • Johann Brink
    Affiliations
    Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia

    Department of Paediatrics, University of Melbourne, Melbourne, Australia

    Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
    Search for articles by this author
  • Christian P. Brizard
    Affiliations
    Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia

    Department of Paediatrics, University of Melbourne, Melbourne, Australia

    Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia

    Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
    Search for articles by this author
  • Igor E. Konstantinov
    Correspondence
    Address for reprints: Igor E. Konstantinov, MD, PhD, Royal Children's Hospital, Flemington Rd, Parkville, 3029, Australia.
    Affiliations
    Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia

    Department of Paediatrics, University of Melbourne, Melbourne, Australia

    Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia

    Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
    Search for articles by this author
Published:February 01, 2020DOI:https://doi.org/10.1016/j.jtcvs.2020.01.039

      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Thoracic and Cardiovascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Konstantinov I.E.
        • Perrier S.L.
        • Naimo P.S.
        • d'Udekem Y.
        Neonatal quadricuspid truncal valve repair with left coronary artery unroofing.
        J Thorac Cardiovasc Surg. 2019; 157: 710-711
        • Naimo P.S.
        • Fricke T.A.
        • d'Udekem Y.
        • Brink J.
        • Weintraub R.G.
        • Brizard C.P.
        • et al.
        Impact of truncal valve surgery on the outcomes of truncus arteriosus repair.
        Eur J Cardiothorac Surg. 2018; 54: 524-531
        • Naimo P.S.
        • Fricke T.A.
        • Yong M.S.
        • d'Udekem Y.
        • Kelly A.
        • Radford D.J.
        • et al.
        Outcomes of truncus arteriosus repair in children: 35 years of experience from a single institution.
        Sem Thorac Cardiovasc Surg. 2016; 28: 500-511
        • Silverman N.H.
        Truncus arteriosus.
        Pediatric echocardiography. Williams & Wilkins, Baltimore1993: 229-243
        • Zoghbi W.A.
        • Enriquez-Sarano M.
        • Foster E.
        • Grayburn P.A.
        • Kraft C.D.
        • Levine R.A.
        • et al.
        Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.
        J Am Soc Echocard. 2003; 16: 777-802
        • Tani L.Y.
        • Minich L.L.
        • Day R.W.
        • Orsmond G.S.
        • Shaddy R.E.
        Doppler evaluation of aortic regurgitation in children.
        Am J Cardiol. 1997; 80: 927-931
        • Russell H.M.
        • Pasquali S.K.
        • Jacobs J.P.
        • Jacobs M.L.
        • O'Brien S.M.
        • Mavroudis C.
        • et al.
        Outcomes of repair of common arterial trunk with truncal valve surgery: a review of the Society of Thoracic Surgeons congenital heart surgery database.
        Ann Thorac Surg. 2012; 93: 164-169
        • Russell H.M.
        • Mavroudis C.D.
        • Backer C.L.
        • Mavroudis C.
        Long-term follow-up after truncal valve repair.
        Cardiol Young. 2012; 22: 718-723
        • Kaza A.K.
        • Burch P.T.
        • Pinto N.
        • Minich L.L.
        • Tani L.Y.
        • Hawkins J.A.
        Durability of truncal valve repair.
        Ann Thorac Surg. 2010; 90: 1307-1312
        • Henaine R.
        • Azarnoush K.
        • Belli E.
        • Capderou A.
        • Roussin R.
        • Planché C.
        • et al.
        Fate of the truncal valve in truncus arteriosus.
        Ann Thorac Surg. 2008; 85: 172-178
        • Konstantinov I.E.
        • Karamlou T.
        • Blackstone E.H.
        • Mosca R.S.
        • Lofland G.K.
        • Caldarone C.A.
        • et al.
        Truncus arteriosus associated with interrupted aortic arch in 50 neonates: a Congenital Heart Surgeons Society study.
        Ann Thorac Surg. 2006; 81: 214-222
        • Bohuta L.
        • Hussein A.
        • Fricke T.A.
        • d'Udekem Y.
        • Bennett M.
        • Brizard C.P.
        • et al.
        Surgical repair of truncus arteriosus associated with interrupted aortic arch: long-term outcomes.
        Ann Thorac Surg. 2011; 91: 1473-1477
        • Imamura M.
        • Drummond-Webb J.J.
        • Sarris G.E.
        • Mee R.B.
        Improving early and intermediate results of truncus arteriosus repair: a new technique of truncal valve repair.
        Ann Thorac Surg. 1999; 67: 1142-1146

      Linked Article

      • Commentary: Truncal root remodeling: A useful technique that can be translated to other lesions?
        The Journal of Thoracic and Cardiovascular SurgeryVol. 161Issue 2
        • Preview
          Naimo 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
        • PDF
      • Commentary: This looks like a great hammer…which nails should we pound?
        The Journal of Thoracic and Cardiovascular SurgeryVol. 161Issue 2
        • Preview
          Naimo 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
        • PDF