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Surgical repair of truncal valve regurgitation

Patrick O Myers1, Victor Bautista-Hernandez, Pedro J del Nido

  • 1Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|April 30, 2013
PubMed

Insights

Truncal valve repair (TVR) is a feasible option for truncus arteriosus patients experiencing regurgitation. Surgical creation of a tricuspid valve offers the best outcomes in this challenging patient group.

Area of Science:

  • Cardiology
  • Congenital Heart Disease
  • Pediatric Cardiac Surgery

Background:

  • Truncal valve regurgitation is a significant risk factor in truncus arteriosus patients.
  • Limited data exists on truncal valve repair (TVR) techniques and outcomes.
  • This study reports on the experience with TVR across all age groups.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of truncal valve repair (TVR).
  • To analyze the effectiveness of TVR in patients with truncus arteriosus.
  • To identify predictors of reoperation after TVR.

Main Methods:

  • Retrospective review of 36 patients (13 neonates, 30 children, 3 adults) who underwent TVR from 1997 to 2012.
  • Analysis of valve morphology (quadricuspid, tricuspid, bicuspid) and repair techniques.
  • Assessment of regurgitation severity, reoperation rates, and survival during a mean follow-up of 38.3 months.

Main Results:

  • 3 early deaths (8%) occurred in neonates. Significant reduction in truncal valve regurgitation from moderate-severe to mild (P < 0.001).
  • 16 patients required reoperation, with 1 needing a second reoperation. Freedom from reoperation was 55.0% at 5 years and 22.9% at 10 years.
  • Neonatal repair (HR 4.1, P=0.03) and leaflet thinning (HR 22.5, P=0.002) were independent predictors of reoperation.

Conclusions:

  • Truncal valve repair is a feasible procedure for truncal valve regurgitation in truncus arteriosus.
  • Surgical creation of a tricuspid truncal valve appears to yield the best outcomes.
  • Further research into optimizing TVR techniques is warranted for this complex patient population.
Abstract

Keywords:
Truncal valve regurgitationTruncal valve repairTruncus arteriosusValve repair

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