Non-Conduit Repair of Truncus Arteriosus

Abstract

Introduction: The procedure of choice for treatment of truncus arteriosus is one-stage repair within the first few months of life. Establishing right ventricle-pulmonary artery direct continuity without conduit can be a good alternative in the absence of valved conduits in developing centers.

Methods: Between January 2021 and June 2021, a total of five patients (three males, two females) underwent definitive repair of truncus arteriosus without an extracardiac conduit. We used the Barbero-Marcial technique to allow age-related growth, eliminate the risk of conduit-related complications, and to avoid forcing a conduit to place in a very small mediastinal space.

Results: The patients' mean age was 31.2 days (11-54 days). Their mean bodyweight was 3.2 kg (2.7-3.8kg). Mean postoperative intensive care unit stay was 39.6 days (7-99 days). There were two mortalities in the intensive care unit on postoperative days 12 and 61 due to lung-related problems. The remaining three cases' mean ventilation time was 15.6 days (8-22 days).

Conclusion: Having access to a valved conduit is still challenging for some centers, and the non-conduit repair technique defined by Barbero-Marcial can be a successful, life-saving alternative easy for young surgeons to perform in newly based centers.

Keywords: Heart Ventricles; Infant; Intensive Care Units; Pulmonary Artery; Truncus Arteriosus.

Fig. 1

A) A longitudinal incision was made into the anterosuperior aspect of the left pulmonary artery. Then, the incision was extended vertically towards the left sinus of Valsalva, leaving a few millimeters of tissue over the truncal root for suturing. Superiorly, the incision was extended towards the left pulmonary orifice. B) Being careful with the left coronary ostium, right pulmonary artery orifice, and truncal valve cusps, new aortic and pulmonary roots were separated from each other using a glutaraldehyde-treated autologous pericardium as an aortopulmonary window patch. Right ventriculotomy incision was made parallel to the first incision, and closure of VSD was done with running suture technique using a Dacron patch through this ventriculotomy. C) The posterior wall was created by suturing left pulmonary artery directly to the left superior oblique margin of the right ventriculotomy with running suture technique. Anastomosis is reinforced with pericardial pledgeted 7-0 polypropylene sutures (not shown). D) A 0,1-mm polytetrafuoroethylene patch was prepared as a monocusp and sutured directly to the new right ventricular outflow tract. E) The anterior wall was constructed by suturing an autologous pericardial patch.