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Outcomes after common arterial trunk repair: Impact of the surgical technique

Published:November 27, 2020DOI:https://doi.org/10.1016/j.jtcvs.2020.10.147

      Abstract

      Objectives

      We compared the risk of mortality and reintervention after common arterial trunk (CAT) repair for different surgical techniques, in particular the reconstruction of the right ventricle outflow tract with left atrial appendage (LAA) without a monocusp.

      Methods

      The study population comprised 125 patients with repaired CAT who were followed-up at our institution between 2000 and 2018. Statistical analysis included Cox proportional hazard models.

      Results

      Median follow-up was 10.6 years. The 10-year survival rate was 88.2% (95% confidence interval [CI], 80.6-92.4) with the poorest outcome for CAT type IV (64.3%; 95% CI, 36.8-82.3; P < .01). In multivariable analysis, coronary anomalies (hazard ratio [HR], 11.63 [3.84-35.29], P < .001) and CAT with interrupted aortic arch (HR, 6.50 [2.10-20.16], P = .001) were substantial and independent risk factors for mortality. Initial repair with LAA was not associated with an increased risk of mortality (HR, 0.37 [0.11-1.24], P = .11). The median age at reintervention was 3.6 years [7.3 days-13.1 years]. At 10 years, freedom from reintervention was greater in the group with LAA repair compared with the valved conduit group, 73.3% (95% CI, 41.3-89.4) versus 17.2% (95% CI, 9.2-27.4) (P < .001), respectively. Using a valved conduit for repair (HR, 4.79 [2.45-9.39], P < .001), truncal valve insufficiency (HR, 2.92 [1.62-5.26], P < .001) and DiGeorge syndrome (HR, 2.01 [1.15-3.51], P = .01) were independent and clinically important risk factors for reintervention.

      Conclusions

      For the repair of CAT, the LAA technique for right ventricle outflow tract reconstruction was associated with comparable survival and greater freedom from reintervention than the use of a valved conduit.

      Graphical abstract

      Key Words

      Abbreviations and Acronyms:

      CAT (common arterial trunk), CI (confidence interval), HR (hazard ratio), LAA (left atrial appendage), MPA (main pulmonary artery), PA (pulmonary artery), RVOT (right ventricle outflow tract), TV (truncal valve)
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      Linked Article

      • Commentary: Right ventricular outflow tract reconstruction during repair of truncus arteriosus: Everything old is new again
        The Journal of Thoracic and Cardiovascular SurgeryVol. 162Issue 4
        • Preview
          Since the first successful repair of truncus arteriosus, perhaps the most widely discussed element of the operation has been the reconstruction of the right ventricular outflow tract (RVOT). The issue remains timely, and a look back at the evolution of surgical management may provide historical context. Berhendt and colleagues1 reported the use of several techniques in their series of earliest survivors. The first patient underwent attempted direct right ventricle–to–pulmonary artery (RVPA) connection but died in the operating room.
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      • Commentary: The story of an appendage: From being the less important part of the heart to becoming the cornerstone of a repair
        The Journal of Thoracic and Cardiovascular SurgeryVol. 162Issue 4
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          Repairing the common arterial trunk requires separation of the pulmonary arteries from the systemic circulation and creating continuity between the right ventricle and the pulmonary arteries.1,2 Generally, reconstruction is performed using a valved conduit to avoid pulmonary valve regurgitation, which, in association with pulmonary artery hypertension, may worsen postoperative right ventricular failure. There are 2 well-known argument against using a valved conduit in neonates: early degeneration and the need for reintervention as the neonate outgrows it.
        • Full-Text
        • PDF