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ABSTRACT
BACKGROUND
Truncal valve insufficiency (TVI) is one of the risk factors for death in neonatal primary repair for common arterial trunk (CAT).
METHODS
In this single-center retrospective case-matched controlled study, 16 consecutive CAT patients from 2000- 2018 with moderate to severe truncal valve regurgitation (TVR2-3) undergoing primary CAT surgery with truncal valve (TrV) repair were matched to 16 CAT patients with none to mild truncal valve regurgitation (TVR1-0).
RESULTS
The TVR2-3 group had 11 (69%) patients with moderate and 5 (31%) with severe TVI, with an operative median age of 7(4 – 19) days. Survival at median follow-up of 17 years post-repair was 70% and 80% in the TVR2-3 and TVR0-1 groups, respectively (p> 0.99), with two early deaths in the TVR2-3 group occurring after reintervention for residual TVI. Rate of surgical TrV re-intervention at 5 years postoperative was 67% for TVR2-3 (p = 0.005). TVR2-3 experienced greater residual TVI at discharge and 1-year post-repair with severity of TrV dysfunction converging between groups as more patients in TVR0-1 developed mild/moderate TVI over time and TVR2-3 patients underwent re-intervention for clinically significant TVI. Significant LV dilation was observed in the TVR2-3 group after 3 years post-repair (p = 0.001), but LVEF was comparable between groups.
CONCLUSIONS
TrV reintervention burden (i.e. repair or replacement) is greater in the TVR2-3 population with higher truncal valve-related early mortality. Progressive LV enlargement in the TVR2-3 group due to residual TVI was well tolerated. Ventricular remodeling did not significantly impact LVEF or clinical status.
Graphical abstract
Graphical Abstract
GLOSSARY OF ABBREVIATIONS:
CAT (common arterial trunk), ECMO (extracorporeal membrane oxygenation), LV (left ventricle), LVEF (left ventricular ejection fraction), TrV (truncal valve), TVI (truncal valve insufficiency), TVS (truncal valve stenosis)Article info
Publication history
Accepted:
February 15,
2023
Received:
December 22,
2022
Publication stage
In Press Accepted ManuscriptFootnotes
There are no conflicts and/or competing interest, no external sources of funding.
The study was approved by the Research Ethics Board at the Hospital for Sick Children and patient consent was waived.
This project was presented as an abstract presentation during the Canadian Cardiovascular Congress 2021(Virtual), October 22, 2021.
KEY TAKEWAYS
Moderate-severe truncal valve insufficiency (TVI) has higher early truncal-valve related mortality and reintervention burden than none-mild TVI
Left ventricular (LV) dilation due to residual TVI was well tolerated and did not affect LV function or cause significant heart failure symptoms
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of The Society of Thoracic Surgeons.
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