Death, reoperation, and late cardiopulmonary function after truncus repair

Abstract

Objective: To identify the late surgical outcomes of truncus arteriosus.

Methods: Fifty consecutive patients with truncus arteriosus who underwent surgery between 1978 and 2020 at our institute were enrolled in this retrospective, single institutional cohort study. The primary outcome was death and reoperation. The secondary outcome was late clinical status, including exercise capacity. The peak oxygen uptake was measured by a ramp-like progressive exercise test on a treadmill.

Results: Nine patients underwent palliative surgery, which resulted in 2 deaths. Forty-eight patients went on to truncus arteriosus repair, including 17 neonates (35.4%). The median age and body weight at repair were 92.5 days (interquartile range, 10-272 days) and 3.85 kg (interquartile range, 2.9-6.5 kg), respectively. The survival rate at 30 years was 68.5%. Significant truncal valve regurgitation (P = .030) was a risk factor for survival. Survival rates were similar between in the early 25 and late 25 patients (P = .452). The freedom from death or reoperation rate at 15 years was 35.8%. Significant truncal valve regurgitation was a risk factor (P = .001). The mean follow-up period in hospital survivors was 15.4 ± 12 years (maximum, 43 years). The peak oxygen uptake, which was performed in 12 long-term survivors at a median duration from repair of 19.7 years (interquartile range, 16.8-30.9 years), was 70.2% of predicted normal (interquartile range, 64.5%-80.4%).

Conclusions: Truncal valve regurgitation was a risk factor for both survival and reoperation, thus improvement of truncal valve surgery is essential for better life prognosis and quality of life. Slightly reduced exercise tolerance was common in long-term survivors.

Keywords: truncal root dilatation; truncal valve regurgitation; truncus arteriosus.

Graphical abstract

Prognoses of patients with truncus arteriosus after surgery by surgical era and strategy.

Figure 1

Prognoses of patients with truncus arteriosus undergoing surgery by surgical era and strategy. Circles represent primary repair. Squares represent staged repair. Open symbols represented survivors. Closed symbols represent mortalities. Neonatal total correction is in red. Total correction after the neonatal period is in blue.

Figure 2

(A) Overall survival and (B) freedom from death or reoperation rates by Kaplan-Meier method. Bars represented 95% CI.

Figure 3

Therapeutic algorithm and outcomes of 50 individual patients with truncus arteriosus undergoing surgery. TrVS, Truncal valve surgery; RVOTR, right ventricular outflow tract reconstruction; L/F, lost to follow-up; bPAB, bilateral pulmonary artery band; RV-PA, right ventricle to pulmonary artery.

Figure 4

Relationship between the truncal root z score and peak oxygen uptake (pvo₂) in late survivors (n = 10).

Figure 5

Truncal valve (TrV) regurgitation was a risk factor for both survival and reoperation. As such, improvement of TrV surgery is essential for better life prognosis and quality of life. Staged repair should be selected for patients with Van Praagh A4. Late exercise capacity was slightly reduced and correlated to the size of truncal root. RVOTR, Right ventricular outflow tract reconstruction; L/F, lost to follow-up; bPAB, bilateral pulmonary artery band; RV-PA, right ventricle to pulmonary artery; F/U, follow-up.