Primary repair of truncus arteriosus: High survival with inevitable reintervention

Objectives: The use of valved conduits to reconstruct the right ventricular outflow tract for early repair of truncus arteriosus has improved patients'survival. However the burden of cardiological and surgical reinterventions becomes an increasing concern as the child grows. Material and Method...

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Hauptverfasser: Sinzobahamvya, N, Kumpikaite, D, Photiadis, J, Brecher, AM, Asfour, B, Urban, AE
Format: Tagungsbericht
Sprache:eng ; ger
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Zusammenfassung:Objectives: The use of valved conduits to reconstruct the right ventricular outflow tract for early repair of truncus arteriosus has improved patients'survival. However the burden of cardiological and surgical reinterventions becomes an increasing concern as the child grows. Material and Methods: 86 patients who underwent truncus complete repair with 4 heterografts and 82 allografts between April 1983 and June 2003 were reviewed. The follow-up for early survivors ranges from one to 240 months (mean: 89, median: 84). Survival and freedom from reinterventions were evaluated according to Kaplan-Meier method. Results: Eight patients died early after repair. Three died late and death was not related to reintervention. Survival was 87.9%±3.6% from one year onwards. A total of 21 interventional dilatations were required: for the original conduit (n=11), for the second conduit (n=2) and for pulmonary artery(ies) (n=8). 35 original grafts and 3 second grafts needed replacement. Four regurgitant truncal valves had to be replaced. Overall rate of reintervention was 1.1 per patient per 10 years. Freedom from first reintervention was 90.4%±3.4%, 69.2%±5.7% and 33.6%±7.4%, at one, five and ten years respectively. Earlier reintervention was necessary for patients who received grafts with z-value less than 2. Conclusions: With the actual management of truncus arteriosus, patients enjoy a high survival. However they will continue to face conduit reintervention as long as a growing and long-lasting graft is not available. Stenosis of the pulmonary arteries and dysfunction of the truncal valve constitute an additional risk for reintervention.
ISSN:0171-6425
1439-1902
DOI:10.1055/s-2004-816743