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Published on: December 11, 2017
Survival After Single-Stage Repair of Truncus Arteriosus and Associated Defects
Anmol Goyal1, Jessica Knight2, Mohammed Hasan1
1Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
Insights
Single-stage repair of truncus arteriosus communis (TAC) shows improved survival. However, concomitant truncal valve surgery increases both in-hospital and long-term mortality in TAC patients.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiac Surgery Outcomes
Background:
- Truncus arteriosus communis (TAC) is a complex congenital heart defect.
- Single-stage repair is a critical intervention for TAC.
- Understanding mortality factors is crucial for improving patient outcomes.
Purpose of the Study:
- To describe in-hospital and long-term mortality after single-stage TAC repair.
- To identify factors associated with mortality after TAC repair.
Main Methods:
- A cohort study of 647 patients undergoing single-stage TAC repair (1982-2011).
- Data sourced from the Pediatric Cardiac Care Consortium registry.
- Long-term mortality assessed via National Death Index matching through 2020.
Main Results:
- 75% of patients survived to hospital discharge.
- 30-year survival after discharge was 78%.
- Concomitant truncal valve surgery was linked to higher in-hospital and 30-year mortality.
Conclusions:
- Concomitant truncal valve surgery, not interrupted aortic arch repair, is associated with increased mortality.
- Optimizing truncal valve intervention timing may enhance TAC repair outcomes.
Background:
The goal of this study was to describe in-hospital and long-term mortality after single-stage repair of truncus arteriosus communis (TAC) and explore factors associated with these outcomes.
Methods:
This was a cohort study of consecutive patients undergoing single-stage TAC repair between 1982 and 2011 reported to the Pediatric Cardiac Care Consortium registry. In-hospital mortality was obtained for the entire cohort from registry records. Long-term mortality was obtained for patients with available identifiers by matching with the National Death Index through 2020. Kaplan-Meier survival estimates were created for up to 30 years after discharge. Cox regression models estimated hazard ratios for the associations with potential risk factors.
Results:
A total of 647 patients (51% male) underwent single-stage TAC repair at a median age of 18 days; 53% had type I TAC, 13% had interrupted aortic arch, and 10% underwent concomitant truncal valve surgery. Of these, 486 (75%) patients survived to hospital discharge. After discharge, 215 patients had identifiers for tracking long-term outcomes; 30-year survival was 78%. Concomitant truncal valve surgery at the index procedure was associated with increased in-hospital and 30-year mortality. Concomitant interrupted aortic arch repair was not associated with increased in-hospital or 30-year mortality.
Conclusions:
Concomitant truncal valve surgery but not interrupted aortic arch was associated with higher in-hospital and long-term mortality. Careful consideration of the need and timing for truncal valve intervention may improve TAC outcomes.
