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Published on: December 11, 2017
Surgical outcomes of common arterial trunk repair beyond infancy
Chinnaswamy Reddy1, Ameya Kaskar1, Govardhan Reddy1
1Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560099 Karnataka India.
Insights
Common arterial trunk repair beyond infancy is challenging but feasible. This study shows satisfactory early and late outcomes, including survival and reintervention rates, for patients undergoing this complex procedure.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Surgical Outcomes Research
Background:
- Common arterial trunk (CAT) is a rare congenital heart defect.
- Surgical repair beyond infancy presents unique challenges.
- Understanding long-term outcomes is crucial for patient management.
Purpose of the Study:
- To analyze the early- and long-term clinical outcomes of common arterial trunk repair in patients presenting beyond infancy.
- To identify factors influencing early mortality in this cohort.
- To evaluate long-term survival and freedom from reintervention and complications.
Main Methods:
- Retrospective analysis of 56 patients undergoing CAT repair beyond infancy (January 2003 - December 2019).
- Data collected included patient demographics, CAT type, surgical techniques, and early/late outcomes.
- Statistical analysis, including univariable analysis, was performed to identify factors affecting mortality.
Main Results:
- Early mortality was 7%. Factors affecting early mortality included age, weight, ventilation duration, and pulmonary hypertensive crisis.
- At 10 years, overall survival was 76.7%.
- Freedom from reintervention for right ventricular outflow tract reconstruction was 89.7%, and freedom from significant truncal valve regurgitation was 66.3%.
Conclusions:
- Repair of common arterial trunk beyond infancy is surgically challenging.
- Satisfactory early and late outcomes, including acceptable mortality and reintervention rates, can be achieved.
- This approach offers a viable option for patients presenting beyond infancy.
Background:
The aim of this study is to analyze the clinical outcomes of common arterial trunk repair beyond infancy in terms of both early- and long-term outcomes.
Methods:
Between January 2003 and December 2019, 56 patients underwent repair for common arterial trunk beyond infancy at our institute. Median age was 34.5 months, 51.8% were females, and 48.2% were males.
Results:
48.2% were type 1, 46.4% were type 2, and 5.4% were type 3. 17.9% patients underwent direct connection technique for right ventricular outflow tract reconstruction; remaining received a conduit. The most common type of truncal valve anatomy was tricuspid (82.1%). Early mortality was 7%. Univariable analysis identified age (p = 0.003), weight (p = 0.04), duration of ventilation (p = 0.036), and pulmonary hypertensive crisis (p ≤ 0.001) as factors affecting early mortality. In our overall cohort of beyond infancy repair for common arterial trunk, at 10 years, the survival, freedom from reintervention for right ventricular outflow tract reconstruction, freedom from ≥ moderate conduit obstruction, freedom from impaired right ventricle function, and freedom from ≥ moderate truncal valve regurgitation were 76.7%, 89.7%, 74%, 88.6%, and 66.3%, respectively.
Conclusion:
Repair for common arterial trunk in patients presenting beyond 1 year of age is challenging; however, it can be done with satisfactory early and late outcomes in terms of mortality and reintervention.
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