Truncus arteriosus repair: A 40-year multicenter perspective |
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| Authors: | Phillip S. Naimo Douglas Bell Tyson A. Fricke Yves d'Udekem Christian P. Brizard Nelson Alphonso Igor E. Konstantinov |
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| Affiliation: | 1. Department of Cardiac Surgery, Royal Children''s Hospital, Melbourne, Australia;2. Department of Paediatrics, University of Melbourne, Melbourne, Australia;3. Murdoch Children''s Research Institute, Melbourne, Australia;4. Queensland Paediatric Cardiac Services, Queensland Children''s Hospital, Brisbane, Australia;5. Faculty of Medicine, University of Queensland, Brisbane, Australia;6. Melbourne''s Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia;1. Department of Cardiac Surgery, Royal Children''s Hospital, Melbourne, Australia;2. Department of Paediatrics, University of Melbourne, Melbourne, Australia;3. Heart Research Group, Murdoch Children''s Research Institute, Melbourne, Australia;4. Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia;1. Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif;2. Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, Calif;3. Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif;4. Department of Cardiology, Kaiser San Francisco Medical Center, San Francisco, Calif;5. Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, Calif;1. Cardiac Surgery Unit, The Royal Children''s Hospital, Melbourne, Australia;2. Department of Paediatrics, The University of Melbourne, Melbourne, Australia;3. Murdoch Children''s Research Institute, Melbourne, Australia;4. Melbourne Children''s Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia;1. Division of Pediatric Cardiothoracic Surgery, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, Colorado;2. Department of Pediatric Cardiology, Children’s Hospital Colorado, Aurora, Colorado;3. Department of Pediatric Radiology, Children’s Hospital Colorado, Aurora, Colorado;1. Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada;2. Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada;3. Division of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio;4. Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts;5. Department of Cardiovascular Surgery, Children’s National Health System, Washington, District of Columbia;6. Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Riley Children’s Health, Indianapolis, Indiana;7. Department of Cardiac Surgery, Nemours Children’s Hospital, Orlando, Florida;8. Pediatric and Congenital Cardiothoracic Surgery, The Methodist Children’s Heart Institute, San Antonio, Texas;9. Pediatric Cardiothoracic Surgery, University of Utah/Primary Children’s Medical Center, Salt Lake City, Utah;10. Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama;11. Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando Florida;12. Congenital Heart Surgeons’ Society Data Center, The Hospital for Sick Children, Toronto, Ontario, Canada;13. Pediatric and Congenital Heart Surgery, Children’s Hospital of Georgia, Augusta, Georgia |
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| Abstract: | ObjectiveTo examine the long-term surgical outcomes of patients who underwent truncus arteriosus (TA) repair.MethodsBetween 1979 and 2018, a total of 255 patients underwent TA repair at 3 Australian hospitals. Data were obtained by review of medical records from initial admission until last cardiology follow-up.ResultsAt the time of TA repair, the median patient age was 44 days, and median weight was 3.5 kg. Early mortality was 13.3% (34 of 255), and overall survival was 76.8 ± 2.9% at 20 years. Neonatal surgery and low operative weight were risk factors for early mortality. Most deaths (82.5%; 47 of 57) occurred within the first year following repair. A coronary artery anomaly and early reoperation were identified as risk factors for late mortality. A total of 175 patients required at least 1 reoperation, with overall freedom of reoperation of 2.9 ± 1.5% at 20 years. Follow-up of survivors was 96% complete (191 of 198). The median duration of follow-up was 16.4 years. At the last follow-up, 190 patients were categorized as New York Heart Association class I/II, and 1 patient was class III.ConclusionsTA repair during the neonatal period presents significant surgical challenges. Neonates with signs of overcirculation should be operated on promptly. A coronary artery anomaly is a risk factor for late mortality. Survival beyond the first year following repair is associated with excellent outcomes. |
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| Keywords: | truncus arteriosus truncal valve congenital heart disease surgery TA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" truncus arteriosus |
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