JTCVS Congenital Truncus Arteriosus
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.Commentary: Assessing risk factors after truncus arteriosus repair—The devil is in the details
In 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 events
The 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
