Abstract
ObjectivesPersistent truncus arteriosus represents less than 3% of all congenital heart defects. We aim to analyze mid-term outcomes after primary Truncus arteriosus repair at different ages and to identify the risk factors contributing to mortality and the need for intervention after surgical repair.MethodsThis retrospective cohort study included 36 children, underwent repair of Truncus arteriosus in the period from January 2011 to December 2018 in two institutions. We recorded the clinical and echocardiographic data for the patients preoperatively, early postoperative, 6 months postoperative, then every year until their last documented follow-up appointment.ResultsThirty-six patients had truncus arteriosus repair during the study period. Thirty-one patients had open sternum post-repair, and two patients required extracorporeal membrane oxygenation. Bleeding occurred in 15 patients (41.67%), and operative mortality occurred in 5 patients (14.7%). Patients with truncus arteriosus type 2 (p = 0.008) and 3 (p = 0.001) and who were ventilated preoperatively (p < 0.001) had a longer hospital stay. Surgical re-intervention was required in 8 patients (22.86%), and 11 patients (30.56%) had catheter-based reintervention. Freedom from reintervention was 86% at 1 year, 75% at 2 years and 65% at 3 years. Survival at 1 year was 81% and at 3 years was 76%. High postoperative inotropic score predicted mortality (p = 0.013).ConclusionRepair of the truncus arteriosus can be performed safely with low morbidity and mortality, both in neonates, infants, and older children. Re-intervention is common, preferably through a transcatheter approach.
Highlights
Truncus arteriosus (TA) represents less than 3% of all congenital heart defects
Previous studies have identified interrupted aortic arch (IAA) and moderate to severe truncal valve regurgitation to be risk factors influencing the mortality after TA repair [1, 6,7,8,9]
We aim to analyze mid-term outcomes after primary TA repair at different ages and to identify the risk factors contributing to mortality and the need for intervention after surgical repair
Summary
Truncus arteriosus (TA) represents less than 3% of all congenital heart defects. It is characterized by a common arterial trunk that arises from the base of the heart and supplies systemic, coronary, and pulmonary circulation. It is associated with ventricular septal defect (VSD) and sometimes, other cardiac lesions such as interrupted aortic arch (IAA), truncal valve stenosis (or regurgitation), and/or hypoplasia of the pulmonary artery branches [1,2,3].The treatment of choice of TA, during the neonatal period, in the current era is primary repair [4, 5]. Truncus arteriosus (TA) represents less than 3% of all congenital heart defects It is characterized by a common arterial trunk that arises from the base of the heart and supplies systemic, coronary, and pulmonary circulation.. It is characterized by a common arterial trunk that arises from the base of the heart and supplies systemic, coronary, and pulmonary circulation.1,2 It is associated with ventricular septal defect (VSD) and sometimes, other cardiac lesions such as interrupted aortic arch (IAA), truncal valve stenosis (or regurgitation), and/or hypoplasia of the pulmonary artery branches [1,2,3]. The treatment of choice of TA, during the neonatal period, in the current era is primary repair [4, 5] This involves separating the pulmonary and systemic pathways through the establishment of a right ventricle to pulmonary artery connection along with VSD closure [6]. Previous studies have identified IAA and moderate to severe truncal valve regurgitation to be risk factors influencing the mortality after TA repair [1, 6,7,8,9]
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