Twenty-Year Experience with Truncus Arteriosus Repair: Changes in Risk Factors in the Current Era
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ORIGINAL ARTICLE
Twenty‑Year Experience with Truncus Arteriosus Repair: Changes in Risk Factors in the Current Era Yoonjin Kang1 · Jae Gun Kwak1 · Jooncheol Min1 · Jae Hong Lim2 · Woong‑han Kim1 Received: 27 February 2020 / Accepted: 16 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Although the clinical outcomes of truncus arteriosus (TA) repair have been improving, few data are available on long-term outcomes after truncus arteriosus repair in the current era. This study evaluated long-term outcome after repair of TA. Fiftyone patients underwent total correction from April 1982 to June 2018. Since 2003, perioperative strategy has changed to minimal priming volume, modified ultrafiltration, and early total repair (n = 26). Mortality and reoperation rates were analyzed before and after 2003. There were 8 hospital deaths after initial operation, all before 1997. During the mean follow-up of 9.8 years, there were 2 deaths. The Kaplan–Meier estimate of survival among all hospital survivors was 94.7% at 5 years and 88.0% at 20 years. A significant independent risk factor for early mortality was operation before 2003 (Hazard ratio (HR) 9.710, p = 0.041) and REV operation (HR 8.000, p = 0.028). Freedom from reoperation for conduit change and TV repair were 88.3% and 41% at 1 and 5 years, and 96.2% and 85.4% at 1 and 5 years, respectively. After 2003, younger age and conduit choice were risk factors for conduit-related reoperation. Initial preoperative TV regurgitation was independent risk factor for sequential TV repair. Patients with TA can undergo total repair of TA with excellent results, especially in current era. Most of the patients require conduit-related reoperations. Younger age and the methods of RVOT reconstruction were risk factors for conduit-related reoperations. TV repair is necessary in limited patients, and initial regurgitation was a risk factor. Keywords Congenital heart disease · CHD · Truncus arteriosus · Reoperation
Introduction Truncus arteriosus (TA) is a rare congenital heart disease that requires surgical repair. The surgical management of TA has evolved toward early total repair, based on advances in surgery, cardiopulmonary bypass, and perioperative management. Neonatal repair is now common and generally successful [1, 2]. However, despite the improved outcomes, survivors still require reoperation due to conduit stenosis or This paper was presented in poster format at the Society of Thoracic Surgeons 55th Annual meeting in San Diego, Jan 27–29, 2019. * Woong‑han Kim [email protected] 1
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, 103 Daehakro, Jongro Gu, Seoul 110‑744, Republic of Korea
Departments of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Republic of Korea
2
truncal valve insufficiency [3, 4]. Few data are available on survival and freedom from reoperation after TA repair in the current era. The optim
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