Outcomes after common arterial trunk repair: Impact of surgical technique

Abstract

To compare the risk of mortality and re-intervention after common arterial trunk (CAT) repair for different surgical techniques, especially for reconstruction of the right ventricle outflow tract (RVOT) with left atrial appendage without a monocusp. We retrospectively included patients with repaired CAT who were followed-up at our institution between 2000 and 2018. A Cox proportional-hazards model was used to investigate risk factors on overall survival and freedom from re-intervention in univariable and multivariable analyses. One hundred and twenty-nine patients were included in the study. The median follow-up was 8.8 years. 15 patients (11.6%) died after the initial repair. The ten-year survival rate was 88.2% with the poorest outcome for CAT type IV (64.3%; P < 0.01). In multivariable analysis, coronary anomalies (HR = 11.63 [3.84–35.29], P < 0.001) and CAT with interrupted aortic arch (HR = 6.50 [2.10–20.16], P = 0.001) were risk factors for mortality. Initial repair without valvulation of the RVOT was not associated with an increased risk of mortality (HR = 0.37 [0.11–1.24], P = 0.11). The median age at re-intervention was 3.6 years [7.3 days-13.1 years]. At 10 years, freedom from re-intervention was higher in the group repaired with left atrial appendage compared to the valved conduit group, 73.3% and 17.2% ( P < 0.001), respectively. In multivariable analysis, using a valved conduit at repair (HR = 4.79 [2.45–9.39], P < 0.001), truncal valve insufficiency (HR = 2.92 [1.62–5.26], P < 0.001) and Di George syndrome (HR = 2.01 [1.15–3.51], P = 0.01) were risk factors for re-intervention. CAT type IV and coronary anomalies were risk factors for mortality after CAT repair. The RVOT reconstruction technique with left atrial appendage was not associated with neither short- nor middle-term higher post-operative mortality. This technique was also associated with a significant increase in the time to re-intervention when the latter was required.