Journal of Chest Surgery

  • 제56권2호
  • /
  • Pages.75-86
  • /
  • 2023
  • /
  • 2765-1606(pISSN)
  • /
  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지
DOI QR코드

DOI QR Code

Outcomes of Surgical Repair for Truncus Arteriosus: A 30-Year Single-Center Experience

  • Yu Ri Lee (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Dong-Hee Kim (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Eun Seok Choi (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Tae-Jin Yun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chun Soo Park (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2022.09.27
  • 심사 : 2022.11.29
  • 발행 : 2023.03.05
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: We investigated the long-term outcomes of truncus arteriosus repair at a single institution with a 30-year study period. Methods: Patients who underwent repair of truncus arteriosus between 1993 and 2022 were reviewed retrospectively. Factors associated with early mortality, overall attrition, and reintervention were identified using appropriate statistical methods. Results: In total, 42 patients were enrolled in this study. The median age and weight at repair were 26 days and 3.5 kg, respectively. Thirty patients (71.4%) underwent 1-stage repair. There were 8 early deaths (19%). In the univariable analysis, undergoing surgery before 2011 was associated with early mortality (p=0.031). The overall survival rate at 10 years was 73.8%. In the multivariable analysis, significant truncal valve (TrV) dysfunction (p=0.010), longer cardiopulmonary bypass time (p=0.018), and the earlier era of surgery (p=0.004) were identified as risk factors for overall mortality. During follow-up, 47 reinterventions were required in 27 patients (64.3%). The freedom from all-cause reintervention rate at 10 years was 23.6%. In the multivariable analysis, associated arch obstruction (p<0.001) and significant TrV dysfunction (p=0.011) were identified as risk factors for all-cause reintervention. Arch obstruction (p=0.027) and a number of TrV cusps other than 3 (p=0.014) were identified as risk factors for right ventricle to pulmonary artery (RV-PA) reintervention, and significant TrV dysfunction was identified as a risk factor for TrV reintervention (p=0.002). Conclusion: Despite recent improvements in survival outcomes after repair of truncus arteriosus, RV-PA or TrV reinterventions were required in a significant number of patients during follow-up.

키워드

참고문헌

  1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol 2002;39:1890-900. https://doi.org/10.1016/s0735-1097(02)01886-7 
  2. Reller MD, Strickland MJ, Riehle-Colarusso T, Mahle WT, Correa A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr 2008;153:807-13. https://doi.org/10.1016/j.jpeds.2008.05.059 
  3. Calder L, Van Praagh R, Van Praagh S, et al. Truncus arteriosus communis: clinical, angiocardiographic, and pathologic findings in 100 patients. Am Heart J 1976;92:23-38. https://doi.org/10.1016/s0002-8703(76)80400-0 
  4. Hazekamp MG, Barron DJ, Dangel J, et al. Consensus document on optimal management of patients with common arterial trunk. Eur J Cardiothorac Surg 2021;60:7-33. https://doi.org/10.1093/ejcts/ezaa423 
  5. Derridj N, Villemain O, Khoshnood B, et al. Outcomes after common arterial trunk repair: impact of the surgical technique. J Thorac Cardiovasc Surg 2021;162:1205-14. https://doi.org/10.1016/j.jtcvs.2020.10.147 
  6. Naimo PS, Bell D, Fricke TA, et al. Truncus arteriosus repair: a 40-year multicenter perspective. J Thorac Cardiovasc Surg 2021;161:P230-40. https://doi.org/10.1016/j.jtcvs.2020.04.149 
  7. Guariento A, Doulamis IP, Staffa SJ, et al. Long-term outcomes of truncus arteriosus repair: a modulated renewal competing risks analysis. J Thorac Cardiovasc Surg 2022;163:224-36. https://doi.org/10.1016/j.jtcvs.2021.01.136 
  8. Ota N, Tachimori H, Hirata Y, et al. Contemporary patterns of the management of truncus arteriosus (primary versus staged repair): outcomes from the Japanese National Cardiovascular Database. Eur J Cardiothorac Surg 2022;61:787-94. https://doi.org/10.1093/ejcts/ezab348 
  9. Hrfi A, Ismail M, Mohammed MH, et al. Outcome of truncus arteriosus repair: 20 years of single-center experience comparing early versus late surgical repair. Cardiol Young 2022;32:1289-95. https://doi.org/10.1017/S104795112100408X 
  10. Mastropietro CW, Amula V, Sassalos P, et al. Characteristics and operative outcomes for children undergoing repair of truncus arteriosus: a contemporary multicenter analysis. J Thorac Cardiovasc Surg 2019;157:2386-98. https://doi.org/10.1016/j.jtcvs.2018.12.115 
  11. Naimo PS, Fricke TA, Yong MS, et al. Outcomes of truncus arteriosus repair in children: 35 years of experience from a single institution. Semin Thorac Cardiovasc Surg 2016;28:500-11. https://doi.org/10.1053/j.semtcvs.2015.08.009 
  12. Tlaskal T, Chaloupecky V, Hucin B, et al. Long-term results after correction of persistent truncus arteriosus in 83 patients. Eur J Cardiothorac Surg 2010;37:1278-84. https://doi.org/10.1016/j.ejcts.2009.12.022 
  13. Collett RW, Edwards JE. Persistent truncus arteriosus; a classification according to anatomic types. Surg Clin North Am 1949;29:1245-70. https://doi.org/10.1016/s0039-6109(16)32803-1 
  14. Baumgartner H, Hung J, Bermejo J, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 2009;22:1-23. https://doi.org/10.1016/j.echo.2008.11.029 
  15. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003;16:777-802. https://doi.org/10.1016/S0894-7317(03)00335-3 
  16. Russell HM, Pasquali SK, Jacobs JP, et al. 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 2012;93:164-9. https://doi.org/10.1016/j.athoracsur.2011.04.121 
  17. Bonilla-Ramirez C, Ibarra C, Binsalamah ZM, et al. Right ventricle to pulmonary artery conduit size is associated with conduit and pulmonary artery reinterventions after truncus arteriosus repair. Semin Thorac Cardiovasc Surg 2022;34:1003-9. https://doi.org/10.1053/j.semtcvs.2021.05.013