Outcomes after common arterial trunk repair: Impact of the surgical technique
- PMID: 33342576
- DOI: 10.1016/j.jtcvs.2020.10.147
Outcomes after common arterial trunk repair: Impact of the surgical technique
Abstract
Objectives: We compared the risk of mortality and reintervention after common arterial trunk (CAT) repair for different surgical techniques, in particular the reconstruction of the right ventricle outflow tract with left atrial appendage (LAA) without a monocusp.
Methods: The study population comprised 125 patients with repaired CAT who were followed-up at our institution between 2000 and 2018. Statistical analysis included Cox proportional hazard models.
Results: Median follow-up was 10.6 years. The 10-year survival rate was 88.2% (95% confidence interval [CI], 80.6-92.4) with the poorest outcome for CAT type IV (64.3%; 95% CI, 36.8-82.3; P < .01). In multivariable analysis, coronary anomalies (hazard ratio [HR], 11.63 [3.84-35.29], P < .001) and CAT with interrupted aortic arch (HR, 6.50 [2.10-20.16], P = .001) were substantial and independent risk factors for mortality. Initial repair with LAA was not associated with an increased risk of mortality (HR, 0.37 [0.11-1.24], P = .11). The median age at reintervention was 3.6 years [7.3 days-13.1 years]. At 10 years, freedom from reintervention was greater in the group with LAA repair compared with the valved conduit group, 73.3% (95% CI, 41.3-89.4) versus 17.2% (95% CI, 9.2-27.4) (P < .001), respectively. Using a valved conduit for repair (HR, 4.79 [2.45-9.39], P < .001), truncal valve insufficiency (HR, 2.92 [1.62-5.26], P < .001) and DiGeorge syndrome (HR, 2.01 [1.15-3.51], P = .01) were independent and clinically important risk factors for reintervention.
Conclusions: For the repair of CAT, the LAA technique for right ventricle outflow tract reconstruction was associated with comparable survival and greater freedom from reintervention than the use of a valved conduit.
Keywords: common arterial trunk; congenital heart defect; left atrial appendage; mortality; reintervention; right ventricle outflow tract; surgery.
Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
Comment in
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Commentary: The story of an appendage: From being the less important part of the heart to becoming the cornerstone of a repair.J Thorac Cardiovasc Surg. 2021 Oct;162(4):1215-1216. doi: 10.1016/j.jtcvs.2020.11.028. Epub 2020 Nov 20. J Thorac Cardiovasc Surg. 2021. PMID: 33334603 No abstract available.
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Commentary: Right ventricular outflow tract reconstruction during repair of truncus arteriosus: Everything old is new again.J Thorac Cardiovasc Surg. 2021 Oct;162(4):1216-1217. doi: 10.1016/j.jtcvs.2020.11.023. Epub 2020 Nov 19. J Thorac Cardiovasc Surg. 2021. PMID: 33334604 No abstract available.
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