Abstract

Surgical repair of Truncus arteriosus aims to improve long term survival. A clear understanding of the natural history and achievable surgical outcomes informs surgical decision making with respect to the timing of surgery. We sought to determine if it is ever too late to repair T. arteriosus. Pubmed and Google scholar were searched between January 1st 1966 and July 31st 2021. The proximal similarly model was used to determine the most externally valid natural history and surgical outcome data. The most externally valid data were used to develop a composite survival graph to help clinicians optimize surgical decision making. Four hundred and twenty eight results were retrieved. Five studies representing 938 patients who had repair of T. arteriosus were included for external validity assessment. The resultant composite graph suggests that repair after 5 month of age, may not improve 15 year survival when compared to non-operative care. T. arteriosus repair after 5 months of age may not improve survival. Key words: Pediatric, truncus artriosus, operative, outcomes.

Highlights

  • Truncus arteriosus is an abnormal ventriculo-arterial connection where the branch pulmonary arteries originate either from a main pulmonary artery that branches off a large common arterial trunk (Type 1) or originate as two separate branches directly from a common arterial trunk(Type 2 and 3)

  • Surgical decision making may be facilitated by considering post-operative survival data in the form of Kaplan-Meier curves

  • We reviewed the literature to establish the most externally valid natural history data for T. arteriosus and the most externally valid surgical

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Summary

Introduction

Truncus arteriosus is an abnormal ventriculo-arterial connection where the branch pulmonary arteries originate either from a main pulmonary artery that branches off a large common arterial trunk (Type 1) or originate as two separate branches directly from a common arterial trunk(Type 2 and 3). (i) Closure of the VSD by routing the left ventricle to the systemic circulation. Surgical decision making may be facilitated by considering post-operative survival data in the form of Kaplan-Meier curves. In this regard, survival curves can be used in 2 ways: to compare surgical outcome with the natural history or to compare the outcomes of different surgical strategies. Valid surgical outcome data, applied in the context of a sound understanding of the natural history of a disease, optimises surgical decision making. Surgical outcomes considered in isolation, could results in patients being offered unnecessary surgery. We reviewed the literature to establish the most externally valid natural history data for T. arteriosus and the most externally valid surgical

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