Survival After Single-Stage Repair of Truncus Arteriosus and Associated Defects

Ann Thorac Surg. 2024 Jan;117(1):153-160. doi: 10.1016/j.athoracsur.2023.06.017. Epub 2023 Jul 4.

Abstract

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.

MeSH terms

  • Aortic Coarctation* / surgery
  • Child
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Heart Defects, Congenital
  • Heart Valves / surgery
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Reoperation
  • Treatment Outcome
  • Truncus Arteriosus / surgery
  • Truncus Arteriosus, Persistent* / surgery

Supplementary concepts

  • Conotruncal cardiac defects