Outcomes after common arterial trunk repair in children

Abstract

The persisting controversy on the repair of the right outflow tract in common arterial trunk led us to analyze the outcomes of children operated at our institution. We identified 153 children diagnosed with CAT between 2000 and 2017. Six patients died before first surgery and were excluded. Types of CAT were classified according to the modified Van Praagh classification. We included 147 patients: CAT A1 ( n = 89, 60.6%), CAT A2 ( n = 32, 21.7%), CAT A3 ( n = 8, 5.4%), and CAT A4 ( n = 18, 12.3%). The mean follow-up was 10 ± 4.4 years. Seventeen patients (11.6%) died after surgery. Mean survival was 88.2% at 5 years. Survival of CAT A4 was significantly lower than for other types (65% at 5 years; P < 0.01). In multivariate analysis, quadricuspid truncal valve anatomy ( P = 0.02, HR = 3.15, 95% CI [1.1961 to 8.3066]) and bovine xenograft valve conduit for the right ventricle outflow tract (RVOT) repair ( P = 0.04, HR = 2.34 [0.8584 to 6.4221]) were the two risk factors for mortality. Seventy-nine patients (53.7%) needed reintervention (surgery or percutaneous). Freedom from reintervention at 5 years was 51.7%. The risk for reintervention was similar in different types of CATs ( P = 0.65). The vast majority of reinterventions were done in the RVOT (96.2%). In univariate analysis, the use of bovine xenografts valve conduit ( P = 0.047, HR = 1.62 [1.12 to 2.51]) and porcine xenografts ( P < 0.01, HR = 2.46 [1.54 to 3.92]) were associated with a higher risk of reinterventions, while autologous connections of the pulmonary artery with the left atrial appendage or pericardial patch were associated with a reduced risk ( P < 0.0001, HR = 0.25 [0,1267 to 0,4779]). The anatomical type of CAT did not influence the risk for reintervention after repair. Autologous reconstruction of the pulmonary artery with autologous tissue limits the risk for reintervention on the RVOT during childhood.