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Goyal A, Knight J, Hasan M, Rao H, Thomas AS, Sarvestani A, St Louis J, Kochilas L, Raghuveer G. Survival After Single-Stage Repair of Truncus Arteriosus and Associated Defects. Ann Thorac Surg 2024; 117:153-160. [PMID: 37414385 DOI: 10.1016/j.athoracsur.2023.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/21/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The goal of this study was to describe in-hospital and long-term mortality after single-stage repair of truncus arteriosus communis (TAC) and explore factors associated with these outcomes. METHODS This was a cohort study of consecutive patients undergoing single-stage TAC repair between 1982 and 2011 reported to the Pediatric Cardiac Care Consortium registry. In-hospital mortality was obtained for the entire cohort from registry records. Long-term mortality was obtained for patients with available identifiers by matching with the National Death Index through 2020. Kaplan-Meier survival estimates were created for up to 30 years after discharge. Cox regression models estimated hazard ratios for the associations with potential risk factors. RESULTS A total of 647 patients (51% male) underwent single-stage TAC repair at a median age of 18 days; 53% had type I TAC, 13% had interrupted aortic arch, and 10% underwent concomitant truncal valve surgery. Of these, 486 (75%) patients survived to hospital discharge. After discharge, 215 patients had identifiers for tracking long-term outcomes; 30-year survival was 78%. Concomitant truncal valve surgery at the index procedure was associated with increased in-hospital and 30-year mortality. Concomitant interrupted aortic arch repair was not associated with increased in-hospital or 30-year mortality. CONCLUSIONS Concomitant truncal valve surgery but not interrupted aortic arch was associated with higher in-hospital and long-term mortality. Careful consideration of the need and timing for truncal valve intervention may improve TAC outcomes.
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Affiliation(s)
- Anmol Goyal
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
| | - Jessica Knight
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia
| | - Mohammed Hasan
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Hussain Rao
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Amanda S Thomas
- Center for Epidemiology and Clinical Research, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Amber Sarvestani
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - James St Louis
- Department of Surgery, Medical College of Georgia, Augusta, Georgia
| | - Lazaros Kochilas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Geetha Raghuveer
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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Mitta A, Vogel AD, Korte JE, Brennan E, Bradley SM, Kavarana MN, Konrad Rajab T, Kwon JH. Outcomes in Primary Repair of Truncus Arteriosus with Significant Truncal Valve Insufficiency: A Systematic Review and Meta-analysis. Pediatr Cardiol 2023; 44:1649-1657. [PMID: 37474609 DOI: 10.1007/s00246-023-03231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023]
Abstract
Data regarding the effect of significant TVI on outcomes after truncus arteriosus (TA) repair are limited. The aim of this meta-analysis was to summarize outcomes among patients aged ≤ 24 months undergoing TA repair with at least moderate TVI. A systematic literature search was conducted in PubMed, Scopus, and CINAHL Complete from database inception through June 1, 2022. Studies reporting outcomes of TA repair in patients with moderate or greater TVI were included. Studies reporting outcomes only for patients aged > 24 months were excluded. The primary outcome was overall mortality, and secondary outcomes included early mortality and truncal valve reoperation. Random-effects models were used to estimate pooled effects. Assessment for bias was performed using funnel plots and Egger's tests. Twenty-two single-center observational studies were included for analysis, representing 1,172 patients. Of these, 232 (19.8%) had moderate or greater TVI. Meta-analysis demonstrated a pooled overall mortality of 28.0% after TA repair among patients with significant TVI with a relative risk of 1.70 (95% CI [1.27-2.28], p < 0.001) compared to patients without TVI. Significant TVI was also significantly associated with an increased risk for early mortality (RR 2.04; 95% CI [1.36-3.06], p < 0.001) and truncal valve reoperation (RR 3.90; 95% CI [1.40-10.90], p = 0.010). Moderate or greater TVI before TA repair is associated with an increased risk for mortality and truncal valve reoperation. Management of TVI in patients remains a challenging clinical problem. Further investigation is needed to assess the risk of concomitant truncal valve surgery with TA repair in this population.
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Affiliation(s)
- Alekhya Mitta
- Division of Cardiothoracic Surgery, Medical University of South Carolina, 114 Doughty Street, Charleston, SC, 29425, USA
| | - Andrew D Vogel
- Division of Cardiothoracic Surgery, Medical University of South Carolina, 114 Doughty Street, Charleston, SC, 29425, USA
| | - Jeffrey E Korte
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Emily Brennan
- Department of Research & Education Services, Medical University of South Carolina, Charleston, SC, USA
| | - Scott M Bradley
- Division of Cardiothoracic Surgery, Medical University of South Carolina, 114 Doughty Street, Charleston, SC, 29425, USA
| | - Minoo N Kavarana
- Division of Cardiothoracic Surgery, Medical University of South Carolina, 114 Doughty Street, Charleston, SC, 29425, USA
| | - T Konrad Rajab
- Division of Cardiothoracic Surgery, Medical University of South Carolina, 114 Doughty Street, Charleston, SC, 29425, USA
| | - Jennie H Kwon
- Division of Cardiothoracic Surgery, Medical University of South Carolina, 114 Doughty Street, Charleston, SC, 29425, USA.
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Hardy WA, Kang L, Turek JW, Rajab TK. Outcomes of truncal valve replacement in neonates and infants: a meta-analysis. Cardiol Young 2023; 33:673-680. [PMID: 36970855 DOI: 10.1017/s1047951123000604] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Infants with truncus arteriosus typically undergo repair by repurposing the truncal valve as the neo-aortic valve and using a valved conduit homograft for the neo-pulmonary valve. In cases where the native truncal valve is too insufficient for repair, it is replaced, but this is a rare occurrence with a paucity of data, especially in the infant population. Here, we conduct a meta-analysis to better understand the outcomes of infant truncal valve replacement during the primary repair of truncus arteriosus. METHODS We systematically reviewed PubMed, Scopus, and CINAHL for all studies reporting infant (<12 months) truncus arteriosus outcomes between 1974 and 2021. Exclusion criteria were studies which did not report truncal valve replacement outcomes separately. Data extracted included valve replacement type, mortality, and reintervention. Our primary outcome was early mortality, and our secondary outcomes were late mortality and reintervention rates. RESULTS Sixteen studies with 41 infants who underwent truncal valve replacement were included. The truncal valve replacement types were homografts (68.8%), mechanical valves (28.1%), and bioprosthetic valves (3.1%). Overall early mortality was 49.4% (95% CI: 28.4-70.5). The pooled late mortality rate was 15.3%/year (95% CI: 5.8-40.7). The overall rate of truncal valve reintervention was 21.7%/year (95% CI: 8.4-55.7). CONCLUSIONS Infant truncal valve replacement has poor early and late mortality as well as high rates of reintervention. Truncal valve replacement therefore remains an unsolved problem in congenital cardiac surgery. Innovations in congenital cardiac surgery, such as partial heart transplantation, are required to address this.
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Affiliation(s)
- William A Hardy
- Section of Pediatric Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Lillian Kang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Joseph W Turek
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - T Konrad Rajab
- Section of Pediatric Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
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4
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Age at surgery and outcomes following neonatal cardiac surgery: An analysis from the Pediatric Cardiac Critical Care Consortium. J Thorac Cardiovasc Surg 2023; 165:1528-1538.e7. [PMID: 35760618 DOI: 10.1016/j.jtcvs.2022.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/22/2022] [Accepted: 05/10/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The optimal timing for neonatal cardiac surgery is a potentially modifiable factor that may affect outcomes. We studied the relationship between age at surgery (AAS) and outcomes across multiple hospitals, focusing on neonatal operations where timing appears is not emergency. METHODS We studied neonates ≥37 weeks' gestation and ≥2.5 kg admitted to a treating hospital on or before day of life 2 undergoing selected index cardiac operations. The impact of AAS on outcomes was evaluated across the entire cohort and a standard risk subgroup (ie, free of preoperative mechanical ventilation, mechanical circulatory support, or other organ failure). Outcomes included mortality, major morbidity (ie, cardiac arrest, mechanical circulatory support, unplanned cardiac reintervention, or neurologic complication), and postoperative cardiac intensive care unit and hospital length of stay. Post hoc analyses focused on operations undertaken between day of life 2 and 7. RESULTS We studied 2536 neonates from 47 hospitals. AAS from day of life 2 through 7 was not associated with risk adjusted mortality or major morbidity among the entire cohort and the standard risk subgroup. Older AAS, although associated with modest increases in postoperative cardiac intensive care unit and hospital length of stay in the entire cohort, was not associated with hospital length of stay in the standard risk subgroup. CONCLUSIONS Among select nonemergency neonatal cardiac operations, AAS between day of life 2 and 7 was not found to be associated with risk adjusted mortality or major morbidity. Although delays in surgical timing may modestly increase preoperative resource use, studies of AAS and outcomes not evident at the time of discharge are needed.
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Buckley JR, Costello JM, Smerling AJ, Sassalos P, Amula V, Cashen K, Riley CM, Bakar AM, Iliopoulos I, Jennings A, Narasimhulu SS, Mastropietro CW. Contemporary Multicenter Outcomes for Truncus Arteriosus With Interrupted Aortic Arch. Ann Thorac Surg 2023; 115:144-150. [PMID: 36084696 DOI: 10.1016/j.athoracsur.2022.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Truncus arteriosus with interrupted aortic arch (TA-IAA) is a rare congenital heart defect with historically poor outcomes. Contemporary multicenter data are limited. METHODS A retrospective cohort study of children who underwent repair of TA-IAA between 2009 and 2016 at 12 tertiary care referral centers within the United States was performed. Major adverse cardiac events (MACE) were defined as postoperative extracorporeal membrane oxygenation, cardiopulmonary resuscitation, or operative mortality. TA-IAA patients were compared with TA patients who underwent repair during the study period from the same institutions. RESULTS We reviewed 35 patients with TA-IAA. MACE occurred in 12 patients (34%). Improvement over time was observed during the study period with 11 events (92%) occurring in the first half of the study period (P = .03). Factors associated with MACE included moderate or severe truncal valve insufficiency (P < .01), concomitant truncal valve repair (P = .04), and longer cardiopulmonary bypass duration (P = .02). In comparison with 216 patients who underwent TA repair, patients with TA-IAA had a higher rate of MACE, but this finding was not statistically significant (34% vs 20%, respectively; P = .07). Additionally no differences between TA-IAA and TA groups were observed for unplanned reoperations (14% vs 22%, respectively; P = .3), hospital length of stay (24 vs 23 days, P = .65), or late deaths (7% vs 7%, P = 1.00). CONCLUSIONS In this contemporary, multicenter cohort the rate of MACE after repair of TA-IAA was high but improved during the study period. Early childhood outcomes of patients with TA-IAA were similar to those with TA.
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Affiliation(s)
- Jason R Buckley
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
| | - John M Costello
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Arthur J Smerling
- Division of Critical Care, Department of Pediatrics, Columbia University College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York, New York, New York
| | - Peter Sassalos
- Section of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Venu Amula
- Division of Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah
| | - Katherine Cashen
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke University School of Medicine, Duke Children's Hospital, Durham, North Carolina
| | - Christine M Riley
- Division of Cardiac Critical Care, Department of Pediatrics, Children's National Health System, Washington, DC
| | - Adnan M Bakar
- Division of Critical Care, Department of Pediatrics, Albany Medical Center, Albany, New York
| | - Ilias Iliopoulos
- Division of Cardiac Critical Care, Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aimee Jennings
- Division of Critical Care, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Sukumar Suguna Narasimhulu
- Division of Cardiac Intensive Care, Department of Pediatrics, University of Central Florida College of Medicine, The Heart Center at Arnold Palmer Hospital for Children, Orlando, Florida
| | - Christopher W Mastropietro
- Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
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Cheung EW, Mastropietro CW, Flores S, Amula V, Radman M, Kwiatkowski D, Puente BN, Buckley JR, Allen K, Loomba R, Kakri K, Chiwane S, Cashen K, Piggott K, Kapileshwarkar Y, Gowda KMN, Badheka A, Raman R, Costello JM, Zang H, Iliopoulos I. Procedural Outcomes of Pulmonary Atresia Intact Ventricular Septum in Neonates: A Multicenter Study. Ann Thorac Surg 2022; 115:1470-1477. [PMID: 36070807 DOI: 10.1016/j.athoracsur.2022.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/10/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Multicenter contemporary data describing short-term outcomes following initial interventions of neonates with pulmonary atresia intact ventricular septum (PA-IVS) are limited. This multicenter study aims to describe characteristics and outcomes of PA-IVS neonates following their initial catheter or surgical intervention and identify factors associated with major adverse cardiac events (MACE). METHODS Neonates with PA-IVS who underwent surgical or catheter intervention between 2009-2019 in 19 centers were reviewed. Risk factors for MACE, defined as cardiopulmonary resuscitation, mechanical circulatory support, stroke, or in-hospital mortality, were analyzed using multivariable logistic regression model. RESULTS We reviewed 279 neonates: 79 (28%) underwent right ventricular decompression, 151 (54%) underwent systemic-to-pulmonary shunt or ductal stent placement only, 36 (13%) underwent right ventricular decompression with shunt or ductal stent placement, and 11 (4%) underwent transplantation. MACE occurred in 57 patients (20%): 26 (9%) received mechanical circulatory support, 37 (13%) received cardiopulmonary resuscitation, 16 (6%) suffered stroke, 23 (8%) died. The presence of two major coronary artery stenoses (adjusted OR: 4.99; 95% CI: 1.16-21.39) and lower weight at first intervention (adjusted OR: 1.52, 95% CI: 1.01-2.27) were significantly associated with MACE. Coronary ischemia was the most frequent presumed mechanism of death (n=10). CONCLUSIONS In a multicenter cohort, one in five neonates with PA-IVS experienced MACE following their initial intervention. Patients with two major coronary artery stenoses or lower weight at time of initial procedure were most likely to experience MACE and warrant vigilance during pre-intervention planning and post-intervention management.
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Affiliation(s)
- Eva W Cheung
- Division of Pediatric Critical Care & Hospital Medicine, Columbia University Irving Medical Center, New York, New York.
| | - Christopher W Mastropietro
- Division of Pediatric Critical Care, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Saul Flores
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Venugopal Amula
- Division of Pediatric Critical Care, University of Utah Health, Salt Lake City, Utah
| | - Monique Radman
- Division of Pediatric Critical Care, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - David Kwiatkowski
- Division of Pediatric Cardiology, Stanford University School of Medicine, Lucille Packard Children's Hospital, Palo Alto, California
| | - Bao Nguyen Puente
- Division of Cardiac Critical Care, Children's National Health System, Washington, District of Columbia
| | - Jason R Buckley
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Kiona Allen
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rohit Loomba
- Department of Pediatrics, Chicago Medical School, Advocate Children's Hospital, Chicago, Illinois
| | - Karan Kakri
- Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Saurabh Chiwane
- Division of Pediatric Critical Care, Saint Louis University, Cardinal Glennon Children's Hospital, Saint Louis, Missouri
| | - Katherine Cashen
- Division of Critical Care Medicine, Duke University, Duke Children's Hospital, Durham, North Carolina
| | - Kurt Piggott
- Department of Pediatrics, LSU School of Medicine Children's Hospital, New Orleans, Louisiana
| | | | | | - Aditya Badheka
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Rahul Raman
- Department of Pediatrics, Mercy Medical Center, Des Moines, Iowa
| | - John M Costello
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Huaiyu Zang
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ilias Iliopoulos
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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7
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Alsoufi B. Commentary: Truncal valve insufficiency: The dilemma between limiting challenges and challenging limits. J Thorac Cardiovasc Surg 2020; 162:1343-1344. [PMID: 33309090 DOI: 10.1016/j.jtcvs.2020.11.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Bahaaldin Alsoufi
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Ky.
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