Multicenter Analysis of Truncal Valve Management and Outcomes in Children with Truncus Arteriosus.
Cardiac valves
Congenital heart defects
Risk factors
Truncus arteriosus
Journal
Pediatric cardiology
ISSN: 1432-1971
Titre abrégé: Pediatr Cardiol
Pays: United States
ID NLM: 8003849
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
28
02
2020
accepted:
25
06
2020
pubmed:
6
7
2020
medline:
14
1
2021
entrez:
5
7
2020
Statut:
ppublish
Résumé
Truncal valve management in patients with truncus arteriosus is a clinical challenge, and indications for truncal valve intervention have not been defined. We sought to evaluate truncal valve dysfunction and primary valve intervention in patients with truncus arteriosus and determine risk factors for later truncal valve intervention. We conducted a retrospective cohort study of children who underwent truncus arteriosus repair at 15 centers between 2009 and 2016. Multivariable competing risk analysis was performed to determine risk factors for later truncal valve intervention. We reviewed 252 patients. Forty-two patients (17%) underwent truncal valve intervention during their initial surgery. Postoperative extracorporeal support, CPR, and operative mortality for patients who underwent truncal valve interventions were statistically similar to the rest of the cohort. Truncal valve interventions were performed in 5 of 64 patients with mild insufficiency; 5 of 16 patients with mild-to-moderate insufficiency; 17 of 35 patients with moderate insufficiency; 5 of 9 patients with moderate-to-severe insufficiency; and all 10 patients with severe insufficiency. Twenty patients (8%) underwent later truncal valve intervention, five of whom had no truncal valve intervention during initial surgical repair. Multivariable analysis revealed truncal valve intervention during initial repair (HR 11.5; 95% CI 2.5, 53.2) and moderate or greater truncal insufficiency prior to initial repair (HR 4.0; 95% CI 1.1, 14.5) to be independently associated with later truncal valve intervention. In conclusion, in a multicenter cohort of children with truncus arteriosus, 17% had truncal valve intervention during initial surgical repair. For patients in whom variable truncal valve insufficiency is present and primary intervention was not performed, late interventions were uncommon. Conservative surgical approach to truncal valve management may be justifiable.
Identifiants
pubmed: 32620981
doi: 10.1007/s00246-020-02405-z
pii: 10.1007/s00246-020-02405-z
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1473-1483Références
Chai PJ, Jacobs JP, Quintessenza JA (2012) Surgery for common arterial trunk. Cardiol Young 22(6):691–695. https://doi.org/10.1017/S1047951112002016
doi: 10.1017/S1047951112002016
pubmed: 23331589
Thompson LD, McElhinney DB, Reddy M, Petrossian E, Silverman NH, Hanley FL (2001) Neonatal repair of truncus arteriosus: continuing improvement in outcomes. Ann Thorac Surg 72(2):391–395
doi: 10.1016/S0003-4975(01)02796-5
Williams JM, de Leeuw M, Black MD, Freedom RM, Williams WG, McCrindle BW (1999) Factors associated with outcomes of persistent truncus arteriosus. J Am Coll Cardiol 34(2):545–553
pubmed: 10440171
Kaza AK, Burch PT, Pinto N, Minich LL, Tani LY, Hawkins JA (2010) Durability of truncal valve repair. Ann Thorac Surg 90(4):1307–1312. https://doi.org/10.1016/j.athoracsur.2010.06.018 (discussion 1312)
doi: 10.1016/j.athoracsur.2010.06.018
pubmed: 20868834
McElhinney DB, Reddy VM, Rajasinghe HA, Mora BN, Silverman NH, Hanley FL (1998) Trends in the management of truncal valve insufficiency. Ann Thorac Surg 65(2):517–524
pubmed: 9485257
Myers PO, Bautista-Hernandez V, del Nido PJ, Marx GR, Mayer JE, Pigula FA, Baird CW (2013) Surgical repair of truncal valve regurgitation. Eur J Cardiothorac Surg 44(5):813–820. https://doi.org/10.1093/ejcts/ezt213
doi: 10.1093/ejcts/ezt213
pubmed: 23625452
Patrick WL, Mainwaring RD, Carrillo SA, Ma M, Reinhartz O, Petrossian E, Selamet Tierney ES, Reddy VM, Hanley FL (2016) Anatomic factors associated with truncal valve insufficiency and the need for truncal valve repair. World J Pediatr Congenit Heart Surg 7(1):9–15. https://doi.org/10.1177/2150135115608093
doi: 10.1177/2150135115608093
pubmed: 26714988
Russell HM, Mavroudis CD, Backer CL, Mavroudis C (2012) Long-term follow-up after truncal valve repair. Cardiol Young 22(6):718–723. https://doi.org/10.1017/S1047951112001618
doi: 10.1017/S1047951112001618
pubmed: 23331593
Russell HM, Pasquali SK, Jacobs JP, Jacobs ML, O'Brien SM, Mavroudis C, Backer CL (2012) Outcomes of repair of common arterial trunk with truncal valve surgery: a review of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg 93(1):164–169. https://doi.org/10.1016/j.athoracsur.2011.04.121 (discussion 169)
doi: 10.1016/j.athoracsur.2011.04.121
pubmed: 22088417
Henaine R, Azarnoush K, Belli E, Capderou A, Roussin R, Planche C, Serraf A (2008) Fate of the truncal valve in truncus arteriosus. Ann Thorac Surg 85(1):172–178. https://doi.org/10.1016/j.athoracsur.2007.07.039
doi: 10.1016/j.athoracsur.2007.07.039
pubmed: 18154803
Perri G, Filippelli S, Polito A, Di Carlo D, Albanese SB, Carotti A (2013) Repair of incompetent truncal valves: early and mid-term results. Interact Cardiovasc Thorac Surg 16(6):808–813. https://doi.org/10.1093/icvts/ivt098
doi: 10.1093/icvts/ivt098
pubmed: 23487600
pmcid: 3653494
Bove EL, Lupinetti FM, Pridjian AK, Beekman RH, Callow LB, Snider AR, Rosenthal A (1993) Results of a policy of primary repair of truncus arteriosus in the neonate. J Thorac Cardiovasc Surg 105(6):1057–1065 (discussion 1065-1056)
pubmed: 8501933
Brown JW, Ruzmetov M, Okada Y, Vijay P, Turrentine MW (2001) Truncus arteriosus repair: outcomes, risk factors, reoperation and management. Eur J Cardiothorac Surg 20(2):221–227
pubmed: 11463535
Hanley FL, Heinemann MK, Jonas RA, Mayer JE Jr, Cook NR, Wessel DL, Castaneda AR (1993) Repair of truncus arteriosus in the neonate. J Thorac Cardiovasc Surg 105(6):1047–1056
pubmed: 8501932
Rajasinghe HA, McElhinney DB, Reddy VM, Mora BN, Hanley FL (1997) Long-term follow-up of truncus arteriosus repaired in infancy: a twenty-year experience. J Thorac Cardiovasc Surg 113(5):869–878. https://doi.org/10.1016/S0022-5223(97)70259-9 (discussion 878-869)
doi: 10.1016/S0022-5223(97)70259-9
pubmed: 9159620
Buckley JR, Amula V, Sassalos P, Costello JM, Smerling AJ, Iliopoulos L, Jennings A, Riley CM, Cashen K, Suguna Narasimhulu S, Gowda KMN, Bakar AM, Wilhelm M, Badheka A, Moser EAS, Mastropietro CW, Collaborative Research in Pediatric Cardiac Intensive Care I (2019) Multicenter analysis of early childhood outcomes after repair of truncus arteriosus. Ann Thorac Surg 107(2):553–559. https://doi.org/10.1016/j.athoracsur.2018.08.094
doi: 10.1016/j.athoracsur.2018.08.094
pubmed: 30696549
pmcid: 30696549
Mastropietro CW, Amula V, Sassalos P, Buckley JR, Smerling AJ, Iliopoulos I, Riley CM, Jennings A, Cashen K, Narasimhulu SS, Narayana Gowda KM, Bakar AM, Wilhelm M, Badheka A, Moser EAS, Costello JM, Collaborative Research in Pediatric Cardiac Intensive Care I (2019) Characteristics and operative outcomes for children undergoing repair of truncus arteriosus: a contemporary multicenter analysis. J Thorac Cardiovasc Surg. https://doi.org/10.1016/j.jtcvs.2018.12.115
doi: 10.1016/j.jtcvs.2018.12.115
pubmed: 30954295
Society of Thoracic Surgeons (2019) STS congenital heart surgery database v3.3. Accessed 24 March 2019
De Leval MR, McGoon DC, Wallace RB, Danielson GK, Mair DD (1974) Management of truncal valvular regurgitation. Ann Surg 180(4):427–432
pubmed: 4414567
pmcid: 1344115
Naimo PS, Fricke TA, d'Udekem Y, Brink J, Weintraub RG, Brizard CP, Konstantinov IE (2018) Impact of truncal valve surgery on the outcomes of the truncus arteriosus repair. Eur J Cardiothorac Surg 54(3):524–531. https://doi.org/10.1093/ejcts/ezy080
doi: 10.1093/ejcts/ezy080
pubmed: 29528381