Outcome of Reoperation After Initial Repair of Truncus Arteriosus: Analysis of 113 patients
Rami Z. Abd-Rabu, *Sameh M. Said, Kimberly A. Holst, Nathaniel W. Taggart, Elena Ashikhmina, Hartzell V. Schaff, Joseph A. Dearani
Mayo Clinc, Rochester, MN
OBJECTIVES: There is a paucity of data regarding reoperation in patients with truncus arteriosus (TA). The aim of this study was to analyze perioperative surgical, clinical, and congenital/anatomical factors and their relation to reoperation and mortality in patients with TA.
METHODS: From September 1967 to June 2015, 113 consecutive patients (60 males, 53%) with TA underwent at least one reoperation (194 total reoperations). Median age (interquartile range IQR) at initial surgery was 4.7 (0.8 to 6.7) years. The association of baseline factors with outcomes was analyzed with Cox regression and hazard ratio (HR) based on IQR change in continuous variables.
RESULTS: Out of 194 reoperations, 170(89%) were conduit re-replacement, 54(29%) truncal valve replacements, and 8(4%) truncal valve repairs.
Baseline truncal valve anatomy was tricuspid in 51(60%) patients, quadricuspid in 19(22%) and bicuspid in 15(18%). At the initial operation (index surgery) 42(38%) patients had either aortic or pulmonary homograft conduit, 66(59%) had bioprosthetic conduit, 2(2%) had a valveless conduit, and 1(1%) had a mechanical conduit.
Late survival was 83.9, 80.4% and 73.5% at 5, 10 and 15 years respectively. Age at initial operation (HR=1.80; 95%CI=1.09-2.95; P=0.021) and associated genetic abnormalities (HR=2.83; 95%CI=1.10-7.28; P=0.031) both were associated with increased late mortality, while coronary artery anomaly (HR=0.39; 95%CI= 0.16-0.95; P= 0.038) was associated with reduced late mortality. Late interventions were branch pulmonary artery stenting in 9 (5%) patients and transcatheter valve-in-valve in two (1%). Freedom from reoperation (after index surgery) was 62.8%, 24.8% and 9.7% at 5, 10 and 15 years respectively. On multivariate analysis both younger age at initial surgery (HR=1.58; 95% CI=2.12-1.19; P=0.002) and initial truncal valve repair (HR=2.02; 95%CI=1.11-3.67; P=0.021) were associated with decreased time to reoperation.
CONCLUSIONS: Reoperations after initial repair of truncus arteriosus can be performed with satisfactory long-term survival and freedom from late interventions. Younger age at initial operation and initial truncal valve repair are associated with higher rate of late interventions.
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