JTCVS Congenital Truncus Arteriosus
Long-term outcomes of truncus arteriosus repair: A modulated renewal competing risks analysisIn this study, we sought to identify independent risk factors for mortality and reintervention after early surgical correction of truncus arteriosus using a novel statistical method.
Outcomes after common arterial trunk repair: Impact of the surgical techniqueWe 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.
The quadricuspid truncal valve: Surgical management and outcomesTo determine the outcomes of patients with a quadricuspid truncal valve (TV) and durability of TV repair.
Commentary: This looks like a great hammer…which nails should we pound?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.
Commentary: Truncal root remodeling: A useful technique that can be translated to other lesions?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.
Characteristics and operative outcomes for children undergoing repair of truncus arteriosus: A contemporary multicenter analysisWe sought to describe characteristics and operative outcomes of children who underwent repair of truncus arteriosus and identify risk factors for the occurrence of major adverse cardiac events (MACE) in the immediate postoperative period in a contemporary multicenter cohort.
Commentary: Assessing risk factors after truncus arteriosus repair—The devil is in the detailsIn the current issue of the Journal, Mastropietro and colleagues1 retrospectively reviewed the results of 216 children who had undergone surgical repair of truncus arteriosus at 15 institutions in the United states between 2009 and 2016. They focused on early outcomes and assessed risk factors associated with major adverse cardiac events (MACE), an outcome variable that combined in-hospital mortality with the requirement for postoperative cardiopulmonary resuscitation or extracorporeal membrane oxygenation support.
Commentary: Clear as mud: Truncus arteriosus and major adverse cardiac eventsThe article in this issue of the Journal by Mastropietro and colleagues1 investigates in-hospital adverse outcomes and their determinants among patients with truncus arteriosus undergoing complete primary repair at 15 selected institutions from 2009 to 2016. Among the 216 patients included, the in-hospital mortality was 6.9%, and the prevalence of major adverse cardiac events (MACE), defined as intraoperative or perioperative cardiopulmonary resuscitation, extracorporeal membrane oxygenation, or death, was 20%.
Commentary: Timing (and size) is everything?Truncus arteriosus (TA) accounts for 1% to 4% of all cases of congenital heart disease.1 McGoon and colleagues2 reported on the first repair of TA with a valved homograft in 1967. Since then, improvements in cardiopulmonary bypass, surgical techniques, and postoperative management have all reduced early mortality.3