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Persistent truncus arteriosus operated during infancy: long-term follow-up
Z Slavik1, B R Keeton, A P Salmon
1Wessex Cardiac and Thoracic Centre, Southampton General Hospital, U.K.
Insights
Surgical correction for persistent truncus arteriosus using antibiotic-sterilized aortic homografts demonstrated low early mortality and excellent long-term outcomes. Most survivors achieved good functional status, with homograft durability supporting favorable prognosis.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Engineering
Background:
- Persistent truncus arteriosus (PTA) is a complex congenital heart defect requiring surgical intervention.
- Early surgical correction is crucial for infant survival and long-term health.
- The use of homografts in pediatric cardiac surgery presents unique challenges and opportunities.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of using antibiotic-sterilized aortic homografts for surgical correction of persistent truncus arteriosus in infants.
- To assess the durability of homografts and the need for reintervention.
- To identify factors influencing outcomes, such as preoperative truncal valve function.
Main Methods:
- A retrospective review of 19 infants undergoing surgical correction for PTA between 1974 and 1988.
- Surgical technique involved right ventricle-to-pulmonary artery continuity with an aortic homograft and ventricular septal defect closure.
- Long-term follow-up assessed mortality, reinterventions, functional status (NYHA class), and homograft performance.
Main Results:
- Low early postoperative mortality (16%) with 3 deaths related to severe aortic regurgitation or preoperative cardiac arrest.
- The 16 survivors were followed for a mean of 7.8 years, with 15 in NYHA class I.
- Four patients required homograft or aortic valve replacement, but 9 of 13 without aortic valve surgery had no significant stenosis or regurgitation at follow-up.
- Median residual peak gradient across the right ventricular outflow tract was 15 mmHg, with no severe homograft regurgitation at follow-up.
Conclusions:
- Surgical repair of persistent truncus arteriosus using antibiotic-sterilized aortic homografts offers low early mortality and excellent long-term survival.
- The homograft demonstrates durable function, with a low incidence of severe regurgitation or stenosis at long-term follow-up.
- Good preoperative truncal valve function is associated with a lower likelihood of requiring subsequent aortic valve surgery.
Abstract:
Between July 1974 and October 1988 19 consecutive infants (mean age 2.7 months, range 5 days to 11.7 months) underwent surgical correction for persistent truncus arteriosus by one surgeon (J.L.M.). Continuity between the right ventricle and pulmonary arteries was achieved with an antibiotic-sterilized aortic homograft (diameter 13-18 mm) together with patch closure of the ventricular septal defect. There were 3 early postoperative deaths (16%): 1 patient had severe aortic regurgitation, the other 2 had preoperative cardiac arrests. Of the latter, 1 had suffered severe cerebral damage, and the other developed recurrent pulmonary hypertensive crises and low cardiac output. The 16 survivors have been followed for 3.1-17.3 years (mean 7.8 years). Four patients required subsequent replacement of the homograft for stenosis, aortic valve replacement for regurgitation, or both (3.0, 4.0, 8.5, and 12.0 years postoperatively). Of the 16 survivors, 15 are in NYHA class I. Of the 13 patients who have not had aortic valve surgery, 9 have no evidence of stenosis or regurgitation. In the 14 children with the original homograft the median of the residual peak gradient across the right ventricular outflow tract is 15 mmHg (range 10-40 mmHg), and no patient has severe homograft regurgitation at follow-up. Repair of persistent truncus arteriosus has been achieved with low early mortality and no late mortality, which reflects excellent long-term function of the homograft. Furthermore, if truncal valve function is good at presentation, patients are unlikely to require aortic valve surgery.