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Ann Thorac Surg 2006;82:2200-2206
© 2006 The Society of Thoracic Surgeons
a Department of Pediatric Cardio-Thoracic Surgery, Royal Liverpool Children’s NHS Trust, Alder Hey Hospital, Liverpool
b Department of Pediatric Cardiology, Royal Liverpool Children’s NHS Trust, Alder Hey Hospital, Liverpool
c Department of Pediatric Cardiology, Royal Manchester Children’s Hospital, Manchester, United Kingdom
Accepted for publication July 10, 2006.
* Address correspondence to Dr Kalavrouziotis, Department of Pediatric Cardio-Thoracic Surgery, Alder Hey Hospital, Eaton Rd, Liverpool L12 2AP, United Kingdom (Email: gkalavrouziotis{at}yahoo.com).
Presented at the Poster Session of the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.
BACKGROUND: Repair of truncus arteriosus communis (TAC) in the neonatal and early infant period has become standard practice in many centers. We report our experience on early primary repair of TAC, with a focus on early and midterm results.
METHODS: From July 1993 to December 2005, 29 patients with median age 28 days (range, 11 to 127), and median body weight 3.1 kg (range, 2.6 to 5.9 kg), underwent primary repair of TAC. The anatomical type of TAC was as follows: A1-2, 27; A3, 0; and A4, 2. Right ventricular outflow tract was reconstructed with an aortic (n = 7) or pulmonary homograft (n = 8), or a bovine (n = 11) or porcine valved xenograft (n = 3). Follow-up was complete for all patients.
RESULTS: Hospital mortality was 3.4% (1 death due to respiratory infection). At a mean follow-up of 74 months (range, 2 to 149), 1 patient died suddenly 2 months after surgery (6-year actuarial survival 93%). Of the 27 midterm survivors, 14 (52%) underwent 30 interventional procedures including percutaneous balloon dilation with or without stenting for right ventricular outflow tract or branch pulmonary artery obstruction. Eight of them were reoperated on for right ventricle-to-pulmonary artery conduit replacement (n = 8, 23%), and aortic valve regurgitation (n = 1, 3.4%). The overall freedom from any reintervention at 6 years was 50%. Aortic valve regurgitation was trace in 15 patients, mild in 8, moderate in 4. All midterm survivors but 1 (26 of 27) had good ventricular function.
CONCLUSIONS: Truncus arteriosus communis repair can be performed early with very low perioperative mortality and satisfactory midterm morbidity; the latter is mainly attributed to right ventricular outflow tract reconstruction. Interventional cardiac catheterization delays inevitable conduit replacement.
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