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Repair of truncus arteriosus in early infancy with antibiotic sterilized aortic homografts
C Alexiou1, B R Keeton, A P Salmon
1Department of Cardiac Surgery, The General Hospital, Southampton, United Kingdom.
Insights
Repair of truncus arteriosus in infants shows good long-term survival. Antibiotic-sterilized aortic homografts demonstrate durability, though truncal valve issues require attention.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Valvular Heart Surgery
Background:
- Truncus arteriosus repair in neonates and infants presents significant surgical challenges.
- Evaluating the long-term outcomes of truncal valve function and homograft durability is crucial.
Purpose of the Study:
- To assess the fate of the truncal valve and antibiotic-sterilized aortic homografts.
- To determine survival rates following truncus arteriosus repair within the first six months of life.
Main Methods:
- A cohort of 23 infants underwent primary repair of truncus arteriosus between 1974 and 1994.
- Aortic antibiotic-sterilized homografts were used to establish right ventricle-pulmonary artery continuity.
- Comprehensive 100% follow-up was conducted for all patients.
Main Results:
- Early mortality was 17.4%, primarily in neonates with severe truncal regurgitation.
- Ten-year freedom from truncal valve replacement was 78.2%, and from homograft replacement was 77.1%.
- Overall 10-year survival was 79%, with hospital survivors achieving 95% survival and excellent functional class.
Conclusions:
- Normal truncal valves are associated with favorable outcomes, minimizing the need for replacement.
- Antibiotic-sterilized aortic homografts exhibit remarkable durability, even in smaller sizes.
- Excellent late survival rates are achievable following truncus arteriosus repair.
Background:
To evaluate the fate of the truncal valve, the antibiotic sterilized aortic homografts, and the survival after repair of truncus arteriosus in the first 6 months of life.
Methods:
Between 1974 and 1994, 23 infants (mean age 1.7 months, range 5 days to 6 months) underwent primary repair of truncus arteriosus by one surgeon (J.L.M). Sixteen were neonates (age range 5 to 30 days). Continuity between the right ventricle and the pulmonary artery was established with an aortic antibiotic sterilized homograft (mean diameter 14.9 mm, range 11 to 17 mm). Follow-up was 100% complete.
Results:
Four neonates with severe truncal regurgitation died early (17.4%). Fourteen patients underwent reoperations. Five had a truncal valve replacement (mean time 7 years, range 6 months to 17 years). Ten-year freedom from truncal valve replacement was 78.2%. Eleven patients had homograft replacement (mean time 12.7 years, range 2 to 26.2 years). Ten-year freedom from homograft replacement for any cause was 77.1% (for homograft-related problems it was 86.7%). Seven patients retained the original homografts (mean time 14.3 years, range 6 to 18.7 years). There was one late death. Overall 10-year survival was 79% and for the hospital survivors it was 95%. All survivors are in New York Heart Association functional class I.
Conclusions:
Abnormal truncal valves pose serious early and late problems but the patients with normal truncal valves do well and seem unlikely to need replacement of these valves. The durability of the antibiotic sterilized aortic homograft even in sizes less than 14 mm is remarkably good. Late survival is excellent.
