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Outcomes after common arterial trunk repair: Impact of the surgical technique

Neil Derridj1, Olivier Villemain2, Babak Khoshnood3

  • 1M3C-Necker Enfants malades, AP-HP, Université de Paris, Paris, France; CRESS, INSERM, INRA, Université de Paris, Paris, France.

The Journal of Thoracic and Cardiovascular Surgery
|December 21, 2020
PubMed

Insights

The left atrial appendage (LAA) technique for common arterial trunk (CAT) repair offers comparable survival and reduced reintervention rates versus valved conduits. This surgical approach improves long-term outcomes for pediatric cardiac patients.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Common arterial trunk (CAT) is a rare congenital heart defect requiring surgical repair.
  • Reconstruction of the right ventricle outflow tract (RVOT) is a critical component of CAT repair.
  • Different techniques exist for RVOT reconstruction, each with potential implications for long-term outcomes.

Purpose of the Study:

  • To compare the risk of mortality and reintervention after common arterial trunk (CAT) repair using different surgical techniques.
  • Specifically, to evaluate the reconstruction of the right ventricle outflow tract (RVOT) with the left atrial appendage (LAA) without a monocusp versus other methods.

Main Methods:

  • A retrospective study of 125 patients with repaired CAT between 2000 and 2018.
  • Utilized Cox proportional hazard models for statistical analysis.
  • Median follow-up duration was 10.6 years.

Main Results:

  • The 10-year survival rate was 88.2%. Poorest outcomes were observed in CAT type IV.
  • Coronary anomalies and CAT with interrupted aortic arch were significant independent risk factors for mortality.
  • Initial repair with LAA was not associated with increased mortality risk.
  • Freedom from reintervention at 10 years was significantly greater with LAA repair (73.3%) compared to valved conduits (17.2%).
  • Valved conduit use, truncal valve insufficiency, and DiGeorge syndrome were independent risk factors for reintervention.

Conclusions:

  • The left atrial appendage (LAA) technique for RVOT reconstruction in CAT repair is associated with comparable survival rates to valved conduits.
  • The LAA technique demonstrates significantly greater freedom from reintervention compared to the use of valved conduits.
  • This suggests the LAA technique may be a favorable option for long-term management of patients with common arterial trunk.
Abstract

Keywords:
common arterial trunkcongenital heart defectleft atrial appendagemortalityreinterventionright ventricle outflow tractsurgery

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