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Wolter A, Haessig A, Kurkevych A, Weichert J, Bosselmann S, Mielke G, Bedei IA, Schenk J, Widriani E, Axt-Fliedner R. Prenatal Diagnosis, Course and Outcome of Patients with Truncus Arteriosus Communis. J Clin Med 2024; 13:4465. [PMID: 39124733 PMCID: PMC11313530 DOI: 10.3390/jcm13154465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Background: The objective of our study was to assess the prenatal course, associated anomalies and postnatal outcome and the predictive value of various prenatal parameters for survival in prenatally diagnosed cases of truncus arteriosus communis (TAC). Methods: We evaluated cases from four centers between 2008 and 2021. Results: In 37/47 cases (78.7%), classification into a Van Praagh sbtype was possible, most had TAC type A1 (18/37 = 48.6%). In 33/47 (70.2%) with available valve details on common trunk valve, most presented with tricuspid valves (13/33 = 39.4%). In the overall sample, 14/47 (29.8%) had relevant insufficiency, and 8/47 (17%) had stenosis. In total, 37/47 (78.7%) underwent karyotyping, with 15/37 (40.5%) showing abnormal results, mainly 22q11.2 microdeletion (9/37 = 24.3%). Overall, 17/47 (36.2%) had additional extracardiac anomalies (17/47 = 36.2%). Additional intracardiac anomalies were present in 30/47 (63.8%), or 32/47 (68.1%) if coronary anomalies were included. Four (8.5%) had major defects. Two (4.3%) intrauterine deaths occurred, in 10 (21.3%) cases, the parents opted for termination, predominantly in non-isolated cases (8/10 = 80.0%). A total of 35/47 (74.5%) were born alive at 39 (35-41) weeks. Three (8.6%) pre-surgical deaths occurred in non-isolated cases. In 32/35 (91.4%), correction surgery was performed. The postoperative survival rate was 84.4% (27/32) over a median follow-up of 51.5 months. Initial intervention was performed 16 (1-71) days postpartum, and 22/32 (68.8%) required re-intervention. Regarding prenatal outcome-predicting parameters, no significant differences were identified between the survivor and non-survivor groups. Conclusions: There exist limited outcome data for TAC. To our knowledge, this is the largest multicenter, prenatal cohort with an intention-to-treat survival rate of almost 85%.
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Affiliation(s)
- Aline Wolter
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig University and University Hospital UKGM Giessen, 35392 Giessen, Germany; (A.H.); (I.A.B.); (J.S.); (E.W.); (R.A.-F.)
| | - Annika Haessig
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig University and University Hospital UKGM Giessen, 35392 Giessen, Germany; (A.H.); (I.A.B.); (J.S.); (E.W.); (R.A.-F.)
| | | | - Jan Weichert
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
| | - Stephan Bosselmann
- Prenatal Medicine, Prenatal Care Center Stuttgart, 70184 Stuttgart, Germany (G.M.)
| | - Gunther Mielke
- Prenatal Medicine, Prenatal Care Center Stuttgart, 70184 Stuttgart, Germany (G.M.)
| | - Ivonne Alexandra Bedei
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig University and University Hospital UKGM Giessen, 35392 Giessen, Germany; (A.H.); (I.A.B.); (J.S.); (E.W.); (R.A.-F.)
| | - Johanna Schenk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig University and University Hospital UKGM Giessen, 35392 Giessen, Germany; (A.H.); (I.A.B.); (J.S.); (E.W.); (R.A.-F.)
| | - Ellydda Widriani
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig University and University Hospital UKGM Giessen, 35392 Giessen, Germany; (A.H.); (I.A.B.); (J.S.); (E.W.); (R.A.-F.)
| | - Roland Axt-Fliedner
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig University and University Hospital UKGM Giessen, 35392 Giessen, Germany; (A.H.); (I.A.B.); (J.S.); (E.W.); (R.A.-F.)
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Moodley A, Meyer HM, Salie S, Human P, Zühlke LJ, Brooks A. Common Arterial Trunk Repair at the Red Cross War Memorial Hospital, Cape Town: A 20-Year Review of Surgical Practice and Outcomes. World J Pediatr Congenit Heart Surg 2024:21501351241256582. [PMID: 39043204 DOI: 10.1177/21501351241256582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND This study describes the 20-year experience of managing common arterial trunk (CAT) in a low-and-middle-income country and compares the early and medium-term outcomes following the transition from conduit to nonconduit repair at the Red Cross War Memorial Children's Hospital. METHODS Single-center retrospective study of consecutive patients aged less than 18 years who underwent repair of CAT from January 1999 to December 2018 at the Red Cross War Memorial Children's Hospital. Patients with interrupted aortic arch or previous pulmonary artery banding were excluded. RESULTS Fifty-four patients had CAT repair during the study period. Thirty-four (63.0%) patients had a conduit repair, and 20 (37.0%) patients had a nonconduit repair. There were two intraoperative deaths. Thirty-day in-hospital mortality was 22.2% (12/54). Overall, in-hospital mortality was 29.6% (16/54). Eight (21.1%) late mortalities were observed. The actuarial survival for the conduit group was 77.5%, 53.4%, and 44.5% at 6, 12, and 27 months, respectively, and the nonconduit group was 58.6% at six months. The overall freedom from reoperation between the conduit group and nonconduit group was 66.2% versus 86.5%, 66.2% versus 76.9%, and 29.8% versus 64.1% at 1, 2, and 8 years, respectively. CONCLUSIONS The outcomes following the transition to nonconduit repair for CAT in a low- and middle-income setting appear to be encouraging. There was no difference in mortality between conduit and nonconduit repairs, and importantly the results suggest a trend toward lower reintervention rates.
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Affiliation(s)
- A Moodley
- Division of Cardio-Thoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - H M Meyer
- Division of Paediatric Anaesthesia, Department of Anesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - S Salie
- Division of Paediatric Critical Care, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
- Paediatric Intensive Care Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - P Human
- Division of Cardio-Thoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - L J Zühlke
- South African Medical Research Council, Francie van Zijl Drive, Cape Town, South Africa
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - A Brooks
- Division of Cardio-Thoracic Surgery, University of Cape Town, Cape Town, South Africa
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Korsuize NA, Bakhuis W, van Wijk B, Grotenhuis HB, Ter Heide H, Cohen de Lara M, Fejzic Z, Schoof PH, Haas F, Steenhuis TJ. Truncus arteriosus from prenatal diagnosis to clinical outcome: a single-centre experience. Cardiol Young 2024:1-7. [PMID: 38738387 DOI: 10.1017/s1047951124025071] [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] [Indexed: 05/14/2024]
Abstract
BACKGROUND The aim of this study was to review our institution's experience with truncus arteriosus from prenatal diagnosis to clinical outcome. METHODS and results: We conducted a single-centre retrospective cohort study for the years 2005-2020. Truncus arteriosus antenatal echocardiographic diagnostic accuracy within our institution was 92.3%. After antenatal diagnosis, five parents (31%) decided to terminate the pregnancy. After inclusion from referring hospitals, 16 patients were offered surgery and were available for follow-up. Right ventricle-to-pulmonary artery continuity was preferably established without the use of a valve (direct connection), which was possible in 14 patients (88%). There was no early or late mortality. Reinterventions were performed in half of the patients at latest follow-up (median follow-up of 5.4 years). At a median age of 5.5 years, 13 out of 14 patients were still without right ventricle-to-pulmonary artery valve, which was well tolerated without signs of right heart failure. The right ventricle demonstrated preserved systolic function as expressed by tricuspid annular plane systolic excursion z-score (-1.4 ± 1.7) and fractional area change (44 ± 12%). The dimensions and function of the left ventricle were normal at latest follow-up (ejection fraction 64.4 ± 6.2%, fractional shortening 34.3 ± 4.3%). CONCLUSIONS This study demonstrates good prenatal diagnostic accuracy of truncus arteriosus. There was no mortality and favourable clinical outcomes at mid-term follow-up, with little interventions on the right ventricle-to-pulmonary artery connection and no right ventricle deterioration. This supports the notion that current perspectives of patients with truncus arteriosus are good, in contrast to the poor historic outcome series. This insight can be used in counselling and surgical decision-making.
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Affiliation(s)
- Nina A Korsuize
- Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Department of Pediatric Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Wouter Bakhuis
- Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Department of Pediatric Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Bram van Wijk
- Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Henriëtte Ter Heide
- Department of Pediatric Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Department of Fetal Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Michelle Cohen de Lara
- Department of Gynecology and Obstetrics, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Zina Fejzic
- Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul H Schoof
- Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Felix Haas
- Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Trinette J Steenhuis
- Department of Pediatric Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Department of Fetal Cardiology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
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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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5
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Hoashi T, Imai K, Okuda N, Komori M, Ono Y, Kurosaki K, Ichikawa H. Death, reoperation, and late cardiopulmonary function after truncus repair. JTCVS OPEN 2023; 14:407-416. [PMID: 37425460 PMCID: PMC10328806 DOI: 10.1016/j.xjon.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 12/17/2022] [Accepted: 01/30/2023] [Indexed: 07/11/2023]
Abstract
Objective To identify the late surgical outcomes of truncus arteriosus. Methods Fifty consecutive patients with truncus arteriosus who underwent surgery between 1978 and 2020 at our institute were enrolled in this retrospective, single institutional cohort study. The primary outcome was death and reoperation. The secondary outcome was late clinical status, including exercise capacity. The peak oxygen uptake was measured by a ramp-like progressive exercise test on a treadmill. Results Nine patients underwent palliative surgery, which resulted in 2 deaths. Forty-eight patients went on to truncus arteriosus repair, including 17 neonates (35.4%). The median age and body weight at repair were 92.5 days (interquartile range, 10-272 days) and 3.85 kg (interquartile range, 2.9-6.5 kg), respectively. The survival rate at 30 years was 68.5%. Significant truncal valve regurgitation (P = .030) was a risk factor for survival. Survival rates were similar between in the early 25 and late 25 patients (P = .452). The freedom from death or reoperation rate at 15 years was 35.8%. Significant truncal valve regurgitation was a risk factor (P = .001). The mean follow-up period in hospital survivors was 15.4 ± 12 years (maximum, 43 years). The peak oxygen uptake, which was performed in 12 long-term survivors at a median duration from repair of 19.7 years (interquartile range, 16.8-30.9 years), was 70.2% of predicted normal (interquartile range, 64.5%-80.4%). Conclusions Truncal valve regurgitation was a risk factor for both survival and reoperation, thus improvement of truncal valve surgery is essential for better life prognosis and quality of life. Slightly reduced exercise tolerance was common in long-term survivors.
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Affiliation(s)
- Takaya Hoashi
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenta Imai
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Naoki Okuda
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Motoki Komori
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshikazu Ono
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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Fetal Echocardiographic Variables Associated with Pre-Surgical Mortality in Truncus Arteriosus: A Pilot Study. Pediatr Cardiol 2023:10.1007/s00246-023-03099-9. [PMID: 36854855 DOI: 10.1007/s00246-023-03099-9] [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: 03/18/2022] [Accepted: 01/10/2023] [Indexed: 03/02/2023]
Abstract
Truncus arteriosus (TA) is a rare congenital heart defect that can be prenatally detected by fetal echocardiography. However, prognostication and prenatal counseling focus primarily on surgical outcomes due to limited fetal and neonatal pre-surgical mortality data. We aimed to describe the incidence and identify predictors of pre-surgical mortality in prenatally detected TA. This two-center, retrospective cohort study included fetuses diagnosed with TA between 01/2010 and 04/2020. The primary outcome was pre-surgical mortality, defined by fetal or neonatal pre-surgical death or primary listing for transplantation prior to discharge. Univariable regression modeling, Chi-square tests, and t tests assessed for associations between prenatal clinical, demographic, and fetal echocardiographic (fetal-echo) variables and pre-surgical mortality. Of 23 pregnancies with prenatal diagnosis of TA, 4 (17%) were terminated. Of the remaining 19, pre-surgical mortality occurred in 4 (26%), including 2 (11%) fetal deaths and 2 (11%) neonatal pre-surgical deaths. No transplantation listings. Of liveborn fetuses (n = 17), 15 (88%) underwent a neonatal surgery, and 1 (6%) required ECMO. As compared to the survivors, the pre-surgical mortality group had a higher likelihood of having left ventricular dysfunction (0% vs. 40%; p = 0.01), right ventricular dysfunction (0% vs. 60%; p = 0.002), cardiovascular profile score < 7 (0% vs. 40%; p = 0.01), skin edema (0% vs. 40%; p = 0.01), and abnormal umbilical venous (UV) Doppler (0% vs. 60%; p = 0.002). The presence of truncal valve regurgitation or stenosis neared significance. In this cohort with prenatally diagnosed TA, there is significant pre-surgical mortality, including fetal death and neonatal pre-surgical death. Termination rate is also high. Fetal-echo variables associated with pre-surgical mortality in this cohort include ventricular dysfunction, low CVP, skin edema, and abnormal UV Doppler. Knowledge about prenatal risk factors for pre-surgical mortality may guide parental counseling and postnatal planning in prenatally diagnosed TA.
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Delany DR, Chowdhury SM, Corrigan C, Buckley JR. Preoperative in-hospital mortality in neonates with critical CHD. Cardiol Young 2022; 32:1794-1800. [PMID: 34961569 PMCID: PMC9462391 DOI: 10.1017/s1047951121004996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Data regarding preoperative mortality in neonates with critical CHD are sparse and would aid patient care and family counselling. The objective of this study was to utilise a multicentre administrative dataset to report the rate of and identify risk factors for preoperative in-hospital mortality in neonates with critical CHD across US centres. STUDY DESIGN The Pediatric Health Information System database was utilised to search for newborns ≤30 days old, born 1 January 2009 to 30 June 2018, with an ICD-9/10 code for d-transposition of the great arteries, truncus arteriosus, interrupted aortic arch, or hypoplastic left heart syndrome. Preoperative in-hospital mortality was defined as patients who died prior to discharge without an ICD code for cardiac surgery or interventional catheterisation. RESULTS Overall preoperative mortality rate was at least 5.4% (690/12,739) and varied across diagnoses (d-TGA 2.9%, TA 8.3%, IAA 5.5%, and HLHS 7.3%) and centres (0-20.5%). In multivariable analysis, risk factors associated with preoperative mortality included preterm delivery (<37 weeks) (OR 2.3, 95% CI: 1.8-2.9; p < 0.01), low birth weight (<2.5 kg) (OR 3.8, 95% CI: 3.0-4.7; p < 0.01), and genetic abnormality (OR 1.6, 95% CI: 1.2-2.2; p < 0.01). Centre average surgical volume was not a significant risk factor. CONCLUSION Approximately 1 in 20 neonates with critical CHD suffered preoperative in-hospital mortality, and rates varied across diagnoses and centres. Better understanding of the factors that drive the variation (e.g. patient factors, preoperative care models, surgical timing) could help identify patient care improvement opportunities and inform conversations with families.
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Affiliation(s)
- Dennis R Delany
- Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Corinne Corrigan
- Quality Management, Medical University of South Carolina, Charleston, SC, USA
| | - Jason R Buckley
- Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
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Healing the Broken Hearts: A Glimpse on Next Generation Therapeutics. HEARTS 2022. [DOI: 10.3390/hearts3040013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular diseases are the leading cause of death worldwide, accounting for 32% of deaths globally and thus representing almost 18 million people according to WHO. Myocardial infarction, the most prevalent adult cardiovascular pathology, affects over half a million people in the USA according to the last records of the AHA. However, not only adult cardiovascular diseases are the most frequent diseases in adulthood, but congenital heart diseases also affect 0.8–1.2% of all births, accounting for mild developmental defects such as atrial septal defects to life-threatening pathologies such as tetralogy of Fallot or permanent common trunk that, if not surgically corrected in early postnatal days, they are incompatible with life. Therefore, both congenital and adult cardiovascular diseases represent an enormous social and economic burden that invariably demands continuous efforts to understand the causes of such cardiovascular defects and develop innovative strategies to correct and/or palliate them. In the next paragraphs, we aim to briefly account for our current understanding of the cellular bases of both congenital and adult cardiovascular diseases, providing a perspective of the plausible lines of action that might eventually result in increasing our understanding of cardiovascular diseases. This analysis will come out with the building blocks for designing novel and innovative therapeutic approaches to healing the broken hearts.
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Sandoval Boburg R, Mustafi M, Hofbeck M, Schlensak C. Surgical repair of severely incompetent quadricuspid truncal valve. J Surg Case Rep 2021; 2021:rjab427. [PMID: 34603684 PMCID: PMC8480526 DOI: 10.1093/jscr/rjab427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/04/2021] [Indexed: 11/13/2022] Open
Abstract
The surgical management of truncus arteriosus poses a constant challenge for the cardiac team treating the patient. A correct diagnosis, surgical therapy and post-operative management are crucial for the survival of the patient. Almost 30% of the patients show an abnormal number of leaflets in the truncal valve (TV), the majority being quadricuspid valves. Additionally, around 25% of the patients show some degree of TV incompetence. We demonstrate an effective way to reconstruct incompetent, quadricuspid valves with good post-operative outcome.
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Affiliation(s)
- Rodrigo Sandoval Boburg
- Department of Thoracic and Cardiovascular Surgery, Tübingen University Hospital, 72076 Tübingen, Germany
| | - Migdat Mustafi
- Department of Thoracic and Cardiovascular Surgery, Tübingen University Hospital, 72076 Tübingen, Germany
| | - Michael Hofbeck
- Department of Pediatric Cardiology and Intensive Medicine, Tübingen University Hospital, 72076 Tübingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, Tübingen University Hospital, 72076 Tübingen, Germany
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Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Galindo A, Rothman A, Mayman GA, Restrepo H. Common arterial trunk in the era of high prenatal detection rates: Results of neonatal palliation and primary repair. J Card Surg 2021; 36:4090-4094. [PMID: 34462970 DOI: 10.1111/jocs.15964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We reviewed our center's experience with common arterial trunk. METHODS We included those with common arterial trunk in Nevada with estimated delivery dates or birth dates between June 2006 and May 2021. We excluded patients with functionally univentricular hearts. RESULTS We identified a total of 39: 32 prenatally and 7 postnatally. Of the 32 prenatally detected, 2 had elective termination, 2 had fetal demise, and 28 were live-born. Of the 7 postnatally diagnosed, 6 had prenatal care without a fetal echocardiogram, and 1 had no prenatal care. Overall, live-born prenatal detection was 28/34 (82%). Prenatal detection for 2006-2009 was 2/6 (33%) and for 2010-2021 was 26/28 (93%) p = .049. Of the 35 live-born infants, 1 died preoperatively, and 34 underwent neonatal surgery. Of the 34, 8 had palliation (birth weight 1.9±0.7 kg, range 0.8-2.6 kg), and 26 had a primary repair (birth weight 3.0±0.3 kg, range 2.6-4.0 kg) p = .0004. For all 34 neonatal surgical procedures, there were 2 (5.9%) deaths; however, there were no subsequent surgical or interventional catheterization mortalities. CONCLUSIONS In Nevada, current state-wide, general population prenatal detection of the common arterial trunk was more than 90%. By employing a combination of neonatal palliation and primary repair, surgical mortality was less than 6% in a cohort that included those with birth weights less than 2.5 kg, truncal valve surgery, and interrupted aortic arches.
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Affiliation(s)
- William N Evans
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ruben J Acherman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Michael L Ciccolo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Juan Lehoux
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA
| | - Alvaro Galindo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Abraham Rothman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Gary A Mayman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Humberto Restrepo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
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Hazekamp MG, Barron DJ, Dangel J, Homfray T, Jongbloed MRM, Voges I. Consensus document on optimal management of patients with common arterial trunk. Eur J Cardiothorac Surg 2021; 60:7-33. [PMID: 34017991 DOI: 10.1093/ejcts/ezaa423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Mark G Hazekamp
- Department of Cardiothoracic Surgery, University Hospital Leiden, Leiden, Netherlands
| | - David J Barron
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Joanna Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Tessa Homfray
- Department of Medical Genetics, Royal Brompton and Harefield hospitals NHS Trust, London, UK
| | - Monique R M Jongbloed
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Inga Voges
- Department for Congenital Cardiology and Pediatric Cardiology, University Medical Center of Schleswig-Holstein, Kiel, Germany
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12
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Naimo PS, Fricke TA, Lee MGY, d'Udekem Y, Weintraub RG, Brizard CP, Konstantinov IE. Long-term outcomes following repair of truncus arteriosus and interrupted aortic arch. Eur J Cardiothorac Surg 2021; 57:366-372. [PMID: 31209463 DOI: 10.1093/ejcts/ezz176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES We aim to evaluate the long-term outcomes following repair of truncus arteriosus with an interrupted aortic arch. METHODS We reviewed all children (n = 24) who underwent repair of truncus arteriosus and an interrupted aortic arch between 1979 and 2018 in a single institution. The morphology of the interrupted aortic arch was type A in 5, type B in 18 and type C in 1. RESULTS The median age at repair was 10 days and the median weight was 3.1 kg. Direct end-to-side anastomosis of the ascending and descending aorta was performed in 16 patients (67%, 16/24), patch augmentation in 5 patients (21%, 5/24) and direct anastomosis with the use of an interposition graft to the descending aorta in 2 patients (8%, 2/24). One patient, the first in the series, underwent interrupted aortic arch repair via subclavian flap aortoplasty prior to truncus repair. A period of deep hypothermic circulatory arrest was used in 16 patients, and isolated cerebral perfusion was used in 8 patients. The early mortality rate was 17% (4 out of 24 patients). There were no late deaths and overall survival was 83 ± 8% [95% confidence interval (CI) 61-93] at 20 years. Freedom from any reoperation was 33 ± 11% (95% CI 14-54) at 5 years and 13 ± 9% (95% CI 2-34) at 10 years. Six patients underwent 10 aortic reoperations. Freedom from aortic arch reoperation was 69 ± 11% (95% CI 42-85) at 10 and 20 years. Follow-up was 95% complete (19/20), with a median follow-up time of 20 years. At last follow-up, no clinically significant aortic arch obstruction was identified in any patient, and all patients were in New York Heart Association Class I/II. CONCLUSIONS Repair of truncus arteriosus with an interrupted aortic arch with direct end-to-side anastomosis results in good survival beyond hospital discharge. Although the long-term functional state of patients is good, reoperation rates are high.
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Affiliation(s)
- Phillip S Naimo
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Tyson A Fricke
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Melissa G Y Lee
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Robert G Weintraub
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
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13
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Jones BA, Conaway MR, Spaeder MC, Dean PN. Hospital Survival After Surgical Repair of Truncus Arteriosus with Interrupted Aortic Arch: Results from a Multi-institutional Database. Pediatr Cardiol 2021; 42:1058-1063. [PMID: 33786651 DOI: 10.1007/s00246-021-02582-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/12/2021] [Indexed: 11/28/2022]
Abstract
Truncus arteriosus (TA) is a major congenital cardiac malformation that requires surgical repair in the first few weeks of life. Interrupted aortic arch (IAA) is an associated malformation that significantly impacts the complexity of the TA operation. The aim of this study was to (1) define the comorbid conditions associated with TA and (2) determine the hospital survival and morbidity of patients with TA with and without an IAA. Data was collected from the Vizient Clinical Database/Resource Manager, formerly University HealthSystem Consortium, which encompasses more than 160 academic medical centers in the United States. The database was queried for patients admitted from 2002 to 2016 who were ≤ 4 months of age at initial admission, diagnosed with TA, and underwent complete surgical repair during that hospitalization. Of the 645 patients with TA who underwent surgery, 98 (15%) had TA with an interrupted aortic arch (TA-IAA). Both TA and TA-IAA were associated with a high prevalence of comorbidities, including DiGeorge syndrome, prematurity, and other congenital malformations. There was no difference in mortality between TA and TA-IAA (13.7-18.4%, p value = 0.227). No comorbid conditions were associated with an increased mortality in either group. However, patients with TA-IAA had a longer post-operative length of stay (LOS) compared to those without IAA (30 versus 40.3 days, p value = 0.001) and this effect was additive with each additional comorbid condition. In conclusion, the addition of IAA to TA is associated with an increased post-operative LOS, but does not increase in-hospital mortality.
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Affiliation(s)
- Brandon A Jones
- Division of Cardiology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA. .,Akron Children's Hospital Heart Center, 215 West Bowery Street, Akron, OH, 44308, USA.
| | - Mark R Conaway
- Division of Translational Research and Applied Statistics, Department of Public Health, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Michael C Spaeder
- Division of Critical Care, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Peter N Dean
- Division of Cardiology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
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14
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15
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Douglas WI, Beers K. Technical considerations in pediatric cardiac surgery. Semin Pediatr Surg 2021; 30:151043. [PMID: 33992311 DOI: 10.1016/j.sempedsurg.2021.151043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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van Nisselrooij AEL, Herling L, Clur SA, Linskens IH, Pajkrt E, Rammeloo LA, Ten Harkel ADJ, Hazekamp MG, Blom NA, Haak MC. The prognosis of common arterial trunk from a fetal perspective: A prenatal cohort study and systematic literature review. Prenat Diagn 2021; 41:754-765. [PMID: 33480066 PMCID: PMC8248090 DOI: 10.1002/pd.5907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/31/2020] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
Objective The limited number of large fetal cohort studies on common arterial trunk (CAT) impedes prenatal counseling at midgestation. This study evaluates the prognosis of CAT from a fetal perspective. Method Fetuses with a prenatally diagnosed CAT were extracted from the PRECOR registry (2002–2016). We evaluated fetal and postnatal survival and the presence of additional morbidity at last follow‐up. Literature databases were searches systematically for additional cases. Results Thirty‐eight cases with a prenatal diagnosis of CAT were identified in our registry, of which 18/38 (47%) opted for pregnancy termination (TOP). Two cases resulted in spontaneous intrauterine demise (10%, 2/20), six cases demised postnatally (33%, 6/18), leaving 60% (12/20) alive, after exclusion of TOP, at a mean age of six (range: 2–10 years). Additional morbidity was found in 42% (5/12) of survivors, including 22q11.2 deletion syndrome, Adams‐Oliver syndrome and intestinal atresia, whereas 8% (1/12) had developmental delay. The remaining 30% (6/12) of survivors appeared isolated with normal development. All of whom six required replacement of the initial right ventricle to pulmonary artery conduit. Additionally, we reviewed 197 literature cases on short‐term outcome. Conclusion The risk of fetal and neonatal demise, as well as significant morbidity amongst survivors, should be included in prenatal counseling for CAT.
What's already known about this topic?
Postnatal cohort studies have reported generally good postoperative results for common arterial trunk (CAT) Prenatal counseling relies primarily on these selected cohorts, due to the lack of prenatal follow‐up studies
What does this study add?
A large cohort study evaluating outcome of fetal CAT beyond the neonatal period and with regard to the presence of genetic diagnoses, extracardiac malformations and neurodevelopment The first systematic literature review on short‐term outcome following a prenatal diagnosis of CAT
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Affiliation(s)
| | - Lotta Herling
- Department of Obstetrics and Gynecology, Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Sally-Ann Clur
- Department of Paediatric Cardiology, Emma Children's Hospital, Academic Medical Center, Amsterdam UMC, Amsterdam, Netherlands
| | - Ingeborg H Linskens
- Department of Obstetrics, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Eva Pajkrt
- Department of Obstetrics, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Lukas A Rammeloo
- Department of Paediatric Cardiology, Emma Children's Hospital, Academic Medical Center, Amsterdam UMC, Amsterdam, Netherlands
| | - Arend D J Ten Harkel
- Department of Paediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Nico A Blom
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Monique C Haak
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, Leiden, Netherlands
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Twenty-Year Experience with Truncus Arteriosus Repair: Changes in Risk Factors in the Current Era. Pediatr Cardiol 2021; 42:123-130. [PMID: 32995903 DOI: 10.1007/s00246-020-02461-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
Although the clinical outcomes of truncus arteriosus (TA) repair have been improving, few data are available on long-term outcomes after truncus arteriosus repair in the current era. This study evaluated long-term outcome after repair of TA. Fifty-one patients underwent total correction from April 1982 to June 2018. Since 2003, perioperative strategy has changed to minimal priming volume, modified ultrafiltration, and early total repair (n = 26). Mortality and reoperation rates were analyzed before and after 2003. There were 8 hospital deaths after initial operation, all before 1997. During the mean follow-up of 9.8 years, there were 2 deaths. The Kaplan-Meier estimate of survival among all hospital survivors was 94.7% at 5 years and 88.0% at 20 years. A significant independent risk factor for early mortality was operation before 2003 (Hazard ratio (HR) 9.710, p = 0.041) and REV operation (HR 8.000, p = 0.028). Freedom from reoperation for conduit change and TV repair were 88.3% and 41% at 1 and 5 years, and 96.2% and 85.4% at 1 and 5 years, respectively. After 2003, younger age and conduit choice were risk factors for conduit-related reoperation. Initial preoperative TV regurgitation was independent risk factor for sequential TV repair. Patients with TA can undergo total repair of TA with excellent results, especially in current era. Most of the patients require conduit-related reoperations. Younger age and the methods of RVOT reconstruction were risk factors for conduit-related reoperations. TV repair is necessary in limited patients, and initial regurgitation was a risk factor.
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18
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Truncal valve repair in children. J Thorac Cardiovasc Surg 2020; 162:1337-1342. [PMID: 33487419 DOI: 10.1016/j.jtcvs.2020.10.161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 11/24/2022]
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Multicenter Analysis of Truncal Valve Management and Outcomes in Children with Truncus Arteriosus. Pediatr Cardiol 2020; 41:1473-1483. [PMID: 32620981 DOI: 10.1007/s00246-020-02405-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
Truncal valve management in patients with truncus arteriosus is a clinical challenge, and indications for truncal valve intervention have not been defined. We sought to evaluate truncal valve dysfunction and primary valve intervention in patients with truncus arteriosus and determine risk factors for later truncal valve intervention. We conducted a retrospective cohort study of children who underwent truncus arteriosus repair at 15 centers between 2009 and 2016. Multivariable competing risk analysis was performed to determine risk factors for later truncal valve intervention. We reviewed 252 patients. Forty-two patients (17%) underwent truncal valve intervention during their initial surgery. Postoperative extracorporeal support, CPR, and operative mortality for patients who underwent truncal valve interventions were statistically similar to the rest of the cohort. Truncal valve interventions were performed in 5 of 64 patients with mild insufficiency; 5 of 16 patients with mild-to-moderate insufficiency; 17 of 35 patients with moderate insufficiency; 5 of 9 patients with moderate-to-severe insufficiency; and all 10 patients with severe insufficiency. Twenty patients (8%) underwent later truncal valve intervention, five of whom had no truncal valve intervention during initial surgical repair. Multivariable analysis revealed truncal valve intervention during initial repair (HR 11.5; 95% CI 2.5, 53.2) and moderate or greater truncal insufficiency prior to initial repair (HR 4.0; 95% CI 1.1, 14.5) to be independently associated with later truncal valve intervention. In conclusion, in a multicenter cohort of children with truncus arteriosus, 17% had truncal valve intervention during initial surgical repair. For patients in whom variable truncal valve insufficiency is present and primary intervention was not performed, late interventions were uncommon. Conservative surgical approach to truncal valve management may be justifiable.
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20
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Naimo PS, Konstantinov IE. Surgery for Truncus Arteriosus: Contemporary Practice. Ann Thorac Surg 2020; 111:1442-1450. [PMID: 32828754 DOI: 10.1016/j.athoracsur.2020.06.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/24/2020] [Accepted: 06/03/2020] [Indexed: 11/12/2022]
Abstract
Surgery for truncus arteriosus has an early mortality of 3% to 20%, with a long-term survival of approximately 75% at 20 years. Nowadays, truncus arteriosus repair is mostly done in the neonatal period together with a single-staged repair of concomitant cardiovascular anomalies. There are many challenging subgroups of patients with truncus arteriosus, including those with clinically significant truncal valve insufficiency, an interrupted aortic arch, or a coronary artery anomaly. In fact, truncal valve competency appears to be the most important factor influencing the outcomes after truncus arteriosus repair. The use of a conduit during truncus arteriosus repair invariably requires reoperation on the right ventricular outflow tract. Through improvements in perioperative techniques over time, many children are now living well into adulthood after repair of truncus arteriosus, albeit with a high rate of reoperation. Despite this, the long-term outcomes of truncus arteriosus repair are good, with many patients being asymptomatic and with a quality of life comparable to the general population.
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Affiliation(s)
- Phillip S Naimo
- Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Igor E Konstantinov
- Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne Center for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Victoria, Australia.
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21
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Johnson JT, Scholtens DM, Kuang A, Feng XY, Eltayeb OM, Post LA, Marino BS. Does Value Vary by Center Surgical Volume for Neonates With Truncus Arteriosus? A Multicenter Study. Ann Thorac Surg 2020; 112:170-177. [PMID: 32768429 DOI: 10.1016/j.athoracsur.2020.05.178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/18/2020] [Accepted: 05/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Truncus arteriosus is a congenital heart defect with high resource use, cost, and mortality. Value assessment (outcome relative to cost) can improve quality of care and decrease cost. This study hypothesized that truncus arteriosus repair at a high-volume center would result in better outcomes at lower cost (higher value) compared with a low-volume center. METHODS This study retrospectively analyzed a multicenter cohort of neonates undergoing truncus arteriosus repair (2004 to 2015) by using the Pediatric Health Information Systems database. Multivariate quantile, logistic, and negative binomial regression models were used to evaluate total hospital cost, in-hospital mortality, ventilation days, intensive care unit length of stay (LOS), hospital LOS, and days of inotropic agent use by center volume (high-volume >3/year) and age at repair while adjusting for sex, ethnicity, race, genetic abnormality, prematurity, low birth weight, concurrent interrupted arch repair, and truncal valve repair. RESULTS Of 1024 neonates with truncus arteriosus, 495 (48%) were treated at high-volume centers. Costs at the 75th percentile were lower at high-volume vs low-volume centers by $28,456 (P = .02) at all ages at repair. Patients at high-volume centers had lower median postoperative ventilation days (5 days vs 6 days; P < .001), intensive care unit LOS (13 days vs 19 days; P < .001), hospital LOS (23 days vs 28 days; P = .02), and inotropic agent use (3 days vs 4 days; P = .004). In-hospital mortality did not differ by center volume. CONCLUSIONS In neonates undergoing truncus arteriosus repair, costs are lower and outcomes are better at high-volume centers, thus resulting in higher value at all ages of repair. Value-based interventions should be considered to improve outcomes and decrease cost in truncus arteriosus care.
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Affiliation(s)
- Joyce T Johnson
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | - Denise M Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alan Kuang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xiang Yu Feng
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Osama M Eltayeb
- Division of Cardiothoracic Surgery, Department of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lori A Post
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bradley S Marino
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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22
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Naimo PS, Bell D, Fricke TA, d'Udekem Y, Brizard CP, Alphonso N, Konstantinov IE. Truncus arteriosus repair: A 40-year multicenter perspective. J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)31137-5. [PMID: 32653289 DOI: 10.1016/j.jtcvs.2020.04.149] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 04/06/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the long-term surgical outcomes of patients who underwent truncus arteriosus (TA) repair. METHODS Between 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. RESULTS At 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. CONCLUSIONS TA 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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Affiliation(s)
- Phillip S Naimo
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Douglas Bell
- Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Tyson A Fricke
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Nelson Alphonso
- Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Melbourne's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.
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23
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Alamri RM, Dohain AM, Arafat AA, Elmahrouk AF, Ghunaim AH, Elassal AA, Jamjoom AA, Al-Radi OO. Surgical repair for persistent truncus arteriosus in neonates and older children. J Cardiothorac Surg 2020; 15:83. [PMID: 32393289 PMCID: PMC7216609 DOI: 10.1186/s13019-020-01114-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/27/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives Persistent truncus arteriosus represents less than 3% of all congenital heart defects. We aim to analyze mid-term outcomes after primary Truncus arteriosus repair at different ages and to identify the risk factors contributing to mortality and the need for intervention after surgical repair. Methods This retrospective cohort study included 36 children, underwent repair of Truncus arteriosus in the period from January 2011 to December 2018 in two institutions. We recorded the clinical and echocardiographic data for the patients preoperatively, early postoperative, 6 months postoperative, then every year until their last documented follow-up appointment. Results Thirty-six patients had truncus arteriosus repair during the study period. Thirty-one patients had open sternum post-repair, and two patients required extracorporeal membrane oxygenation. Bleeding occurred in 15 patients (41.67%), and operative mortality occurred in 5 patients (14.7%). Patients with truncus arteriosus type 2 (p = 0.008) and 3 (p = 0.001) and who were ventilated preoperatively (p < 0.001) had a longer hospital stay. Surgical re-intervention was required in 8 patients (22.86%), and 11 patients (30.56%) had catheter-based reintervention. Freedom from reintervention was 86% at 1 year, 75% at 2 years and 65% at 3 years. Survival at 1 year was 81% and at 3 years was 76%. High postoperative inotropic score predicted mortality (p = 0.013). Conclusion Repair of the truncus arteriosus can be performed safely with low morbidity and mortality, both in neonates, infants, and older children. Re-intervention is common, preferably through a transcatheter approach.
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Affiliation(s)
- Rawan M Alamri
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed M Dohain
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia.,Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Giza, Egypt
| | - Amr A Arafat
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Ahmed F Elmahrouk
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt. .,Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
| | - Abdullah H Ghunaim
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Elassal
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Zagazig University, Zagazig, Egypt
| | - Ahmed A Jamjoom
- Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Osman O Al-Radi
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
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24
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Hames DL, Mills KI, Thiagarajan RR, Teele SA. Extracorporeal Membrane Oxygenation in Infants Undergoing Truncus Arteriosus Repair. Ann Thorac Surg 2020; 111:176-183. [PMID: 32335016 DOI: 10.1016/j.athoracsur.2020.03.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Infants undergoing truncus arteriosus (TA) repair suffer one of the highest mortality rates of all congenital heart defects. Extracorporeal membrane oxygenation (ECMO) can support patients undergoing TA repair, but little is known about factors contributing to mortality in this cohort. The objective of this study was to identify risk factors for mortality in infants with TA requiring perioperative ECMO. METHODS Data from the Extracorporeal Life Support Organization from 2002 to 2017 for infants less than 60 days old undergoing TA repair were analyzed. Demographics, clinical characteristics, and ECMO characteristics and complications were compared between survivors and nonsurvivors. Multivariable logistic regression was used to evaluate independent risk factors for mortality. RESULTS Of 245 patients analyzed, 92 (37.6%) survived to discharge. Nonsurvivors had a lower weight and a longer ECMO duration. A higher proportion of nonsurvivors suffered complications on ECMO, including mechanical complications, circuit thrombus, bleeding, and need for renal replacement therapy. In multivariable analysis lower weight (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.33-0.95), duration of ECMO (OR, 1.1; 95% CI, 1.02-1.18), need for renal replacement therapy (OR, 3.23; 95% CI, 1.68-6.2), cardiopulmonary resuscitation on ECMO (OR, 11.52; 95% CI, 1.3-102.33), and infection on ECMO (OR, 4.47; 95% CI, 1.2-16.64) were independently associated with mortality. CONCLUSIONS Many factors associated with mortality for infants requiring perioperative ECMO with TA repair are related to complications suffered on ECMO. Thoughtful patient selection and meticulous ECMO management to prevent complications are essential in improving outcomes for these infants.
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Affiliation(s)
- Daniel L Hames
- Department of Cardiology, Division of Cardiovascular Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Kimberly I Mills
- Department of Cardiology, Division of Cardiovascular Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ravi R Thiagarajan
- Department of Cardiology, Division of Cardiovascular Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah A Teele
- Department of Cardiology, Division of Cardiovascular Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Herrmann JL, Larson EE, Mastropietro CW, Rodefeld MD, Turrentine MW, Nozaki R, Brown JW. Right Ventricular Outflow Tract Reconstruction in Infant Truncus Arteriosus: A 37-year Experience. Ann Thorac Surg 2020; 110:630-637. [PMID: 31904368 DOI: 10.1016/j.athoracsur.2019.11.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/08/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Multiple conduits for right ventricular outflow tract reconstruction exist, although the ideal conduit that maximizes outcomes remains controversial. We evaluated long-term outcomes and compared conduits for right ventricular outflow tract reconstruction in children with truncus arteriosus. METHODS Records of patients who underwent truncus arteriosus repair at our institution between 1981 and 2018 were retrospectively reviewed. Primary outcomes included survival and freedom from catheter reintervention or reoperation. Secondary analyses evaluated the effect of comorbidity, operation era, conduit type, and conduit size. RESULTS One hundred patients met inclusion criteria. Median follow-up time was 15.6 years (interquartile range, 5.3-22.2). Actuarial survival at 30 days, 5 years, 10 years, and 15 years was 85%, 72%, 72%, and 68%, respectively. Early mortality was associated with concomitant interrupted aortic arch (hazard ratio, 5.4; 95% confidence interval, 1.7-17.4; P = .005). Median time to surgical reoperation was 4.6 years (interquartile range, 2.9-6.8; n = 58). Right ventricle to pulmonary artery continuity was established with an aortic homograft (n = 14), pulmonary homograft (n = 41), or bovine jugular vein conduit (n = 36) in most cases. Multivariate analysis revealed longer freedom from reoperation with the bovine jugular vein conduit compared with the aortic homograft (hazard ratio, 3.1; 95% confidence interval, 1.3-7.7; P = .02) with no difference compared with the pulmonary homograft. Larger conduit size was associated with longer freedom from reoperation (hazard ratio, 0.7; 95% confidence interval, 0.6-0.9; P < .001). CONCLUSIONS The bovine jugular vein conduit is a favorable conduit for right ventricular outflow tract reconstruction in patients with truncus arteriosus. Concomitant interrupted aortic arch is a risk factor for early mortality.
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Affiliation(s)
- Jeremy L Herrmann
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Section of Congenital Cardiac Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
| | - Emilee E Larson
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Section of Congenital Cardiac Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Christopher W Mastropietro
- Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mark D Rodefeld
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Section of Congenital Cardiac Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Mark W Turrentine
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Section of Congenital Cardiac Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Ryoko Nozaki
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan; Faculty of Medicine, Department of Surgery, University of Tsukuba, Ibaraki, Japan
| | - John W Brown
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Section of Congenital Cardiac Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
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26
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Riley CM, Mastropietro CW, Sassalos P, Buckley JR, Costello JM, Iliopoulos I, Jennings A, Cashen K, Suguna Narasimhulu S, Gowda KMN, Smerling AJ, Wilhelm M, Badheka A, Bakar A, Moser EAS, Amula V. Utilization of inhaled nitric oxide after surgical repair of truncus arteriosus: A multicenter analysis. CONGENIT HEART DIS 2019; 14:1078-1086. [PMID: 31713327 DOI: 10.1111/chd.12849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/14/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Elevated pulmonary vascular resistance (PVR) is common following repair of truncus arteriosus. Inhaled nitric oxide (iNO) is an effective yet costly therapy that is frequently implemented postoperatively to manage elevated PVR. OBJECTIVES We aimed to describe practice patterns of iNO use in a multicenter cohort of patients who underwent repair of truncus arteriosus, a lesion in which recovery is often complicated by elevated PVR. We also sought to identify patient and center factors that were more commonly associated with the use of iNO in the postoperative period. DESIGN Retrospective cohort study. SETTING 15 tertiary care pediatric referral centers. PATIENTS All infants who underwent definitive repair of truncus arteriosus without aortic arch obstruction between 2009 and 2016. INTERVENTIONS Descriptive statistics were used to demonstrate practice patterns of iNO use. Bivariate comparisons of characteristics of patients who did and did not receive iNO were performed, followed by multivariable mixed logistic regression analysis using backward elimination to identify independent predictors of iNO use. MAIN RESULTS We reviewed 216 patients who met inclusion criteria, of which 102 (46%) received iNO in the postoperative period: 69 (68%) had iNO started in the operating room and 33 (32%) had iNO initiated in the ICU. Median duration of iNO use was 4 days (range: 1-21 days). In multivariable mixed logistic regression analysis, use of deep hypothermic circulatory arrest (odds ratio: 3.2; 95% confidence interval: 1.2, 8.4) and center (analyzed as a random effect, p = .02) were independently associated with iNO use. CONCLUSIONS In this contemporary multicenter study, nearly half of patients who underwent repair of truncus arteriosus received iNO postoperatively. Use of iNO was more dependent on individual center practice rather than patient characteristics. The study suggests a need for collaborative quality initiatives to determine optimal criteria for utilization of this important but expensive therapy.
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Affiliation(s)
- Christine M Riley
- Department of Pediatrics, Division of Cardiac Critical Care, Children's National Health System, Washington, District of Columbia
| | - Christopher W Mastropietro
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Peter Sassalos
- Department of Cardiac Surgery, Section of Pediatric Cardiovascular Surgery, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Jason R Buckley
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - John M Costello
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Ilias Iliopoulos
- Department of Pediatrics, Division of Cardiac Critical Care, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aimee Jennings
- Department of Pediatrics, Division of Critical Care, Seattle Children's Hospital, Seattle, Washington
| | - Katherine Cashen
- Department of Pediatrics, Division of Critical Care, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Sukumar Suguna Narasimhulu
- Department of Pediatrics, Division of Cardiac Intensive Care, University of Central Florida College of Medicine, The Heart Center at Arnold Palmer Hospital for Children, Orlando, Florida
| | - Keshava M N Gowda
- Department of Pediatrics, Division of Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Arthur J Smerling
- Department of Pediatrics, Division of Critical Care, Columbia University College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York, New York, New York
| | - Michael Wilhelm
- Department of Pediatrics, Division of Cardiac Intensive Care, University of Wisconsin, Madison, Wisconsin
| | - Aditya Badheka
- Department of Pediatrics, Division of Critical Care Medicine, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Adnan Bakar
- Department of Pediatrics, Division of Cardiac Critical Care, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,Cohen Children's Medical Center, New Hyde Park, New York
| | - Elizabeth A S Moser
- Department of Biostatistics, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, Indiana
| | - Venu Amula
- Department of Pediatrics, Division of Critical Care Medicine, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah
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Sawy AE, Nagy M, Afifi A, Hosny H, Romeih S, Aguib H, Yacoub M. Characterization of size, shape and pattern of flow in the neo-aorta and pulmonary artery in a patient following an innovative technique of repair for truncus arteriosus. Glob Cardiol Sci Pract 2019; 2019:e201918. [PMID: 31799292 PMCID: PMC6865202 DOI: 10.21542/gcsp.2019.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background. Truncus arteriosus (TA) caries a very poor prognosis. In the absence of early correction, only 12 percent of patients born with this anomaly survive beyond one year. There is no agreement about the best method of surgical correction of this anomaly. We have devised an innovative valveless technique using autologous arterial tissue to repair TA. Objectives. Characterizing the size, shape and pattern of flow in the neo-aorta and pulmonary artery, in a patient following the new technique. Patient and Methods. Cardiac MRI and multislice CT imaging, followed by offline computerized image analysis was used in a patient aged 3 months, within 3 weeks of operating. Results. The size, shape and topology of the neo-aorta and pulmonary artery, approximated that present in normal hearts. The pattern of flow in the reconstructed vessels was laminar, throughout the cardiac cycle with minor acceleration during systole. The pulmonary regurgitation resulting from the absence of a valve occurred during late diastole, and was well tolerated. The size of the right ventricle diminished considerably following operation, and the right ventricular ejection fraction was supernormal. Conclusion. This early study in one patient provides new unique data of the size, shape, topology and pattern of flow in the neo-aorta and pulmonary artery, which appear to approximate normality. The long-term results of this promising operation need to be studied.
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Affiliation(s)
- Amr El Sawy
- Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Magdi Yacoub Heart Foundation, Egypt
| | - Mohamed Nagy
- Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Magdi Yacoub Heart Foundation, Egypt
| | - Ahmed Afifi
- Department of Surgery, Aswan Heart Centre, Magdi Yacoub Heart Foundation, Egypt
| | - Hatem Hosny
- Department of Surgery, Aswan Heart Centre, Magdi Yacoub Heart Foundation, Egypt
| | - Soha Romeih
- Department of Radiology, Aswan Heart Centre, Magdi Yacoub Heart Foundation, Egypt
| | - Heba Aguib
- Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Magdi Yacoub Heart Foundation, Egypt
| | - Magdi Yacoub
- Department of Surgery, Aswan Heart Centre, Magdi Yacoub Heart Foundation, Egypt.,National Heart and Lung Institute, Imperial College London, UK
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Naimo PS, Fricke TA, d'Udekem Y, Brink J, Weintraub RG, Brizard CP, Konstantinov IE. Impact of truncal valve surgery on the outcomes of the truncus arteriosus repair. Eur J Cardiothorac Surg 2019. [PMID: 29528381 DOI: 10.1093/ejcts/ezy080] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Preoperative moderate or greater truncal valve (TV) insufficiency is one of the most important factors influencing mortality in children with truncus arteriosus. We therefore sought to determine the impact of TV insufficiency and concomitant TV surgery on children who underwent truncus arteriosus repair at a single institution. METHODS We reviewed 180 patients who underwent truncus arteriosus repair between 1979 and 2016. Preoperative echocardiography demonstrated TV insufficiency in 80 patients (mild: 33.9%, 61/180; moderate: 9.4%, 17/180 and severe: 1.1%, 2/180). RESULTS Twenty-one patients had concomitant TV surgery with an early mortality of 19% (4/21) and overall survival of 70.8 ± 10.1% at 25 years. There were 60 neonates, 11 of whom had concomitant TV surgery with an early mortality of 27% (3/11) and overall survival of 62.3 ± 15.0% at 20 years. Concomitant TV repair (P = 0.5) was not a risk factor for death. TV reoperation was common in those who had concomitant TV surgery, with freedom from reoperation of 19.2 ± 14.9% at 20 years. In the remaining 159 patients, 14 required subsequent TV surgery, and the freedom from TV surgery was 84.0 ± 4.6% at 20 years. At a median follow-up of 18.5 years, TV insufficiency was none or trivial in 79.6% (109/137) and mild or less in 98.5% (135/137) of patients. CONCLUSIONS Most patients with mild TV insufficiency are free from TV surgery up to 25 years. The durability of TV repair is poor. Most patients with moderate or greater TV insufficiency and a quadricuspid TV will require TV surgery.
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Affiliation(s)
- Phillip S Naimo
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Tyson A Fricke
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Johann Brink
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Robert G Weintraub
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Cardiology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
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29
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Mastropietro CW, Amula V, Sassalos P, Buckley JR, Smerling AJ, Iliopoulos I, Riley CM, Jennings A, Cashen K, Narasimhulu SS, Narayana Gowda KM, Bakar AM, Wilhelm M, Badheka A, Moser EAS, Costello JM. Characteristics and operative outcomes for children undergoing repair of truncus arteriosus: A contemporary multicenter analysis. J Thorac Cardiovasc Surg 2019; 157:2386-2398.e4. [PMID: 30954295 DOI: 10.1016/j.jtcvs.2018.12.115] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 11/20/2018] [Accepted: 12/22/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE We sought to describe characteristics and operative outcomes of children who underwent repair of truncus arteriosus and identify risk factors for the occurrence of major adverse cardiac events (MACE) in the immediate postoperative period in a contemporary multicenter cohort. METHODS We conducted a retrospective review of children who underwent repair of truncus arteriosus between 2009 and 2016 at 15 centers within the United States. Patients with associated interrupted or obstructed aortic arch were excluded. MACE was defined as the need for postoperative extracorporeal membrane oxygenation, cardiopulmonary resuscitation, or operative mortality. Risk factors for MACE were identified using multivariable logistic regression analysis and reported as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS We reviewed 216 patients. MACE occurred in 44 patients (20%) and did not vary significantly over time. Twenty-two patients (10%) received postoperative extracorporeal membrane oxygenation, 26 (12%) received cardiopulmonary resuscitation, and 15 (7%) suffered operative mortality. With multivariable logistic regression analysis (which included adjustment for center effect), factors independently associated with MACE were failure to diagnose truncus arteriosus before discharge from the nursery (OR, 3.1; 95% CI, 1.3-7.4), cardiopulmonary bypass duration >150 minutes (OR, 3.5; 95% CI, 1.5-8.5), and right ventricle-to-pulmonary artery conduit diameter >50 mm/m2 (OR, 4.7; 95% CI, 2.0-11.1). CONCLUSIONS In a contemporary multicenter analysis, 20% of children who underwent repair of truncus arteriosus experienced MACE. Early diagnosis, shorter duration of cardiopulmonary bypass, and use of smaller diameter right ventricle-to-pulmonary artery conduits represent potentially modifiable factors that could decrease morbidity and mortality in this fragile patient population.
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Affiliation(s)
- Christopher W Mastropietro
- Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Ind.
| | - Venu Amula
- Division of Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah
| | - Peter Sassalos
- Section of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Mich
| | - Jason R Buckley
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina Children's Hospital, Charleston, SC
| | - 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, NY
| | - Ilias Iliopoulos
- Division of Cardiac Critical Care, Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christine M Riley
- Division of Cardiac Critical Care, Department of Pediatrics, Children's National Health System, Washington, DC
| | - Aimee Jennings
- Division of Critical Care, Department of Pediatrics, Seattle Children's Hospital, Seattle, Wash
| | - Katherine Cashen
- Division of Critical Care, Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Mich
| | - 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, Fla
| | | | - Adnan M Bakar
- Division of Cardiac Critical Care, Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center of NY, New Hyde Park, NY
| | - Michael Wilhelm
- Division of Cardiac Intensive Care, Department of Pediatrics, University of Wisconsin, Madison, Wis
| | - Aditya Badheka
- Division of Critical Care Medicine, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Elizabeth A S Moser
- Department of Biostatistics, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indianapolis, Ind
| | - John M Costello
- Divisions of Cardiology and Critical Care Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill
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30
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Buckley JR, Amula V, Sassalos P, Costello JM, Smerling AJ, Iliopoulos I, Jennings A, Riley CM, Cashen K, Suguna Narasimhulu S, Gowda KMN, Bakar AM, Wilhelm M, Badheka A, Moser EA, Mastropietro CW. Multicenter Analysis of Early Childhood Outcomes After Repair of Truncus Arteriosus. Ann Thorac Surg 2019; 107:553-559. [DOI: 10.1016/j.athoracsur.2018.08.094] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/22/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022]
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31
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Morgan CT, Tang A, Fan CP, Golding F, Manlhiot C, van Arsdell G, Honjo O, Jaeggi E. Contemporary Outcomes and Factors Associated With Mortality After a Fetal or Postnatal Diagnosis of Common Arterial Trunk. Can J Cardiol 2018; 35:446-452. [PMID: 30935635 DOI: 10.1016/j.cjca.2018.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Common arterial trunk (CAT) is a rare anomaly with a spectrum of pathology. We sought to identify current trends and factors associated with postnatal outcomes. METHODS This was a single-centre review including 153 live births with planned surgery. Patients were analyzed as 2 cohorts based on era of CAT diagnosis (1990 to 1999 vs 2000 to 2014) and complexity of disease (simple vs complex). "Complex" required the association with significant aortic arch obstruction, truncal valve (TV) stenosis/regurgitation, and/or branch pulmonary artery (PA) hypoplasia, respectively. RESULTS Sixteen (10%) died preoperatively, and this outcome was associated with significant TV stenosis (odds ratio [OR] 4.55; P = 0.01) and regurgitation (OR 3.17; P = 0.04); 130 (95%) of 137 operated infants underwent primary complete repair. Their survival rates to 1 year improved from 54% to 85% after 2000, although this outcome remained substantially lower for cases with a complex vs simple CAT repair (76% vs 95%; OR 6.46; P = 0.006). Other risk factors associated with decreased 1-year survival included diagnosis before 2000 (OR 4.48; P = 0.038) and a lower birth weight (OR 8.0 per kg weight; P = 0.001). Finally, of 93 survivors beyond year 1 of life, 76 (82%) had undergone a total of 224 reinterventions. Only 15 (16%) were alive without any surgical or catheter-based reintervention at study end. CONCLUSIONS Despite recent surgical improvements, postnatal mortality continues to be substantial if CAT is complicated by significant pathology of the TV, aortic arch, or branch PAs. Reoperations and catheter interventions are eventualities for most patients during childhood.
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Affiliation(s)
- Conall T Morgan
- Divisions of Cardiology and Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Angela Tang
- Divisions of Cardiology and Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Chun-Po Fan
- Divisions of Cardiology and Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Fraser Golding
- Divisions of Cardiology and Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cedric Manlhiot
- Divisions of Cardiology and Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Glen van Arsdell
- Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Osami Honjo
- Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Edgar Jaeggi
- Divisions of Cardiology and Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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Outcomes of truncus arteriosus repair with bovine jugular vein conduit. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:365-369. [PMID: 32082765 DOI: 10.5606/tgkdc.dergisi.2018.14841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 03/15/2018] [Indexed: 11/21/2022]
Abstract
Background In this study, we aimed to evaluate the outcomes of truncus arteriosus repair in patients undergoing Rastelli type truncus arteriosus. Methods A total of 13 patients (7 males, 6 females; median age 37 days; range, 16 to 60 days) underwent repair of truncus arteriosus using Contegra conduits between January 2011 and March 2 017. P reoperative d iagnosis w as t runcus a rteriosus type 1 (Edwards-Collett) in eight, type 2 in three, type 3 in one, and type 4 in one patient. Contegra conduits used for operations were 14 mm (n=5), 12 mm (n=7), and 16 mm (n=1). Results Early death was seen in two patients (15.4%). The median intensive care and hospital stays were 10 (range, 6 to 14) and 20 (range, 14 to 41) days, respectively. The median follow-up was 36 (range, 2 to 66) months. In four patients (31%), the conduit sizes severely increased during follow-up and reached 23 mm in two patients and 20 mm in one patient, and 18 mm in the other patient. Three patients had moderate distal conduit stenosis. Moderate pulmonary insufficiency was detected in four patients and severe pulmonary insufficiency in one patient. Two patients had moderate truncal valve insufficiency and one patient had moderate residual ventricular septal defect. None of the patients needed reoperation. Conclusion Contegra conduit is a good alternative for repair of truncus arteriosus in infants; however close follow-up is necessary, as distal conduit stenosis and conduit dilatation may develop.
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Parikh R, Eisses M, Latham GJ, Joffe DC, Ross FJ. Perioperative and Anesthetic Considerations in Truncus Arteriosus. Semin Cardiothorac Vasc Anesth 2018; 22:285-293. [PMID: 29808750 DOI: 10.1177/1089253218778826] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Truncus arteriosus is a congenital cardiac lesion in which failure of embryonic truncal septation results in a single semilunar valve and single arterial trunk providing both pulmonary and systemic circulations. Most patients with this lesion are symptomatic in the neonatal period with cyanosis and/or congestive heart failure and undergo complete repair in the first weeks of life. This review will focus on the anatomy, physiology, and perioperative anesthetic management of patients with truncus arteriosus.
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Affiliation(s)
| | - Michael Eisses
- 2 University of Washington, Seattle, WA, USA.,3 Seattle Children's Hospital, Seattle, WA, USA
| | - Gregory J Latham
- 2 University of Washington, Seattle, WA, USA.,3 Seattle Children's Hospital, Seattle, WA, USA
| | - Denise C Joffe
- 2 University of Washington, Seattle, WA, USA.,3 Seattle Children's Hospital, Seattle, WA, USA.,4 University of Washington Medical Center, Seattle, WA, USA
| | - Faith J Ross
- 2 University of Washington, Seattle, WA, USA.,3 Seattle Children's Hospital, Seattle, WA, USA
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Outcomes of Right Ventricular Outflow Tract Reconstruction for Children with Persistent Truncus Arteriosus: A 10-Year Single-Center Experience. Pediatr Cardiol 2018; 39:565-574. [PMID: 29255914 DOI: 10.1007/s00246-017-1789-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022]
Abstract
The purpose of this report is to assess the mid- and long-term outcomes of right ventricular outflow tract (RVOT) reconstruction for children with persistent truncus arteriosus. Between September 2006 and 2016, 105 patients with persistent truncus arteriosus (PTA) received surgical treatment at Shanghai Children's Medical Center. Direct right ventricle-pulmonary artery anastomosis (pulmonary artery pull-down) was performed in 51 patients; a left auricle or pericardial conduit was inserted between the RVOT and pulmonary artery as a connection in 17 patients; heterograft (bovine jugular vein or Gore-tex) conduits and homograft conduits were used in 30 and 7 cases, respectively, to connect the distal pulmonary and right ventricle outflow tract; and pulmonary valve reconstruction was performed in 38 patients using a Gore-tex monocusp. There were six in-hospital deaths and one delayed death 5 months after operation. After a mean follow-up of 55.8 ± 16.5 months (6-113 months), 19 patients underwent reoperation (3 with pulmonary patch enlargement, 14 with conduit replacement and 2 with aortic valve replacement) 10-89 months after the first operation, with 1 hospital death. The actuarial survival rates were 94.2, 93.3 and 93.3% at 1, 5 and 10 years, respectively. Freedom from reoperation was 98.0, 87.8 and 82.7% at 1, 5 and 10 years, respectively. The follow-up variables included echocardiography, chest radiography, cardiac CT and cardiac function. At the last examination, most of the patients exhibited an improvement of New York Heart Association functional class from III or IV preoperatively to I or II at follow-up. Surgical treatment for PTA has an acceptable survival rate and satisfactory outcomes. Most patients exhibited an improvement in cardiac function during follow-up. Aortic arch deformity, truncal valvular regurgitation and long cardiopulmonary bypass time were regarded as risk factors for hospital mortality. Autologous tissue has a lower reoperation rate and better growth potential than extracardiac conduits. A monocusp valve effectively reduces pulmonary regurgitation in the early postoperative stage.
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Animasahun BA, Ogunlana AT, Gbelee HO. The Burden of Truncus Arteriosus in an Urban City in Africa: How are we Fairing? Heart Views 2017; 18:121-124. [PMID: 29326774 PMCID: PMC5755192 DOI: 10.4103/1995-705x.221226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The true incidence of truncus arteriosus in underdeveloped countries is difficult to determine. This is due largely to underreporting as a result of nonavailability of technologically advanced facilities to make definitive diagnosis prenatally. There is a lack of data on the profile and outcome of patients with persistent truncus arteriosus (PTA) in Nigeria. This study aims to document the demographic characteristics, mode of presentation, indications for echocardiography, associated anomalies, average age at diagnosis, and outcome of patients with truncus arteriosus in our center. Methods: Prospective and cross-sectional involving consecutive patients diagnosed with PTA using echocardiography at the Paediatric Department of Lagos State University Teaching Hospital, Lagos, Nigeria as part of a large study between January 2008 and December 2015. Results: Only 25 patients had PTA during the study period. The prevalence of PTA among children presenting at the study center during the study period was 7.9/100,000. It constituted 2.4% of the cases of congenital heart disease and 7.1% of cases of cyanotic congenital heart disease. The male:female ratio was 1:1.1. The ages of the patients at diagnosis ranged between 0.75 and 153 months with a mean age at diagnosis ± standard deviation of 18.4 months ± 37.7. Only about 40% of patients were diagnosed within the neonatal period. Cyanosis was the most frequent indication for evaluation. Conclusion: PTA is as common in Nigeria as in the other parts of the world but diagnosed late. Cyanosis is the most common presenting feature.
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Affiliation(s)
- Barakat Adeola Animasahun
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Nigeria.,Department of Paediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Aminat Titilayo Ogunlana
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Nigeria.,Department of Paediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Henry Olusegun Gbelee
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Nigeria.,Department of Paediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria
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Ramírez-Marroquín S, Curi-Curi PJ, Calderón-Colmenero J, García-Montes JA, Cervantes-Salazar JL. Common Arterial Trunk Repair by Means of a Handmade Bovine Pericardial-Valved Woven Dacron Conduit. World J Pediatr Congenit Heart Surg 2016; 8:69-76. [PMID: 28033080 DOI: 10.1177/2150135116674439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surgical repair of common arterial trunk (CAT) by means of a homograft conduit has become a standard practice. We report our experience in the correction of this heart disease with a handmade bovine pericardial-valved woven Dacron conduit as an alternative procedure to homografts, with a focus on early, mid-term, and long-term results. METHODS We designed a retrospective study that included 15 patients with a mean age of 1.5 years (range: three months to eight years), who underwent primary repair of simple CAT. Right ventricular outflow tract was reconstructed in all the cases with this handmade graft that was explanted at the time of its biological stenotic degeneration. A peeling procedure was performed at this time, in order to reconstruct the right ventricle-to-pulmonary artery continuity. RESULTS Overall mortality was 13.3% (one death at the early postoperative primary repair and the other at the mid-term postoperative peeling reoperation). Actuarial survival rate was 93.3%, 86.7%, and 86.7% at 5, 10, and 15 years, respectively. All of the 14 survivors developed stenosis of the handmade conduit at the mid-term period (8 ± 3 years), but after the peeling procedure, 13 survivors remain asymptomatic to date. CONCLUSIONS Primary repair of common arterial trunk using a handmade conduit can be performed with very low perioperative mortality and satisfactory mid-term and long-term results, which can be favorably compared with those reported with the use of homografts. When graft obstruction develops, peeling procedure is a good option because it does not affect the overall survival, although long-term outcomes warrant further follow-up.
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Affiliation(s)
- Samuel Ramírez-Marroquín
- 1 Department of Pediatric Cardiac and Congenital Heart Disease Surgery, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Pedro José Curi-Curi
- 1 Department of Pediatric Cardiac and Congenital Heart Disease Surgery, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Juan Calderón-Colmenero
- 2 Department of Pediatric Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - José Antonio García-Montes
- 2 Department of Pediatric Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Jorge Luis Cervantes-Salazar
- 1 Department of Pediatric Cardiac and Congenital Heart Disease Surgery, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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Common Arterial Trunk in a 3-Day-Old Alpaca Cria. Case Rep Vet Med 2016; 2016:4609126. [PMID: 29955416 PMCID: PMC6005283 DOI: 10.1155/2016/4609126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/31/2016] [Indexed: 12/02/2022] Open
Abstract
A 3-day-old alpaca cria presented for progressive weakness and dyspnea since birth. Complete bloodwork, thoracic radiographs, and endoscopic examination of the nasal passages and distal trachea revealed no significant findings. Echocardiogram and contrast study revealed a single artery overriding a large ventricular septal defect (VSD). A small atrial septal defect or patent foramen ovale was also noted. Color flow Doppler and an agitated saline contrast study revealed bidirectional but primarily right to left flow through the VSD and bidirectional shunting through the atrial defect. Differential diagnosis based on echocardiographic findings included common arterial trunk, Tetralogy of Fallot, and pulmonary atresia with a VSD. Postmortem examination revealed a large common arterial trunk with a quadricuspid valve overriding a VSD. Additionally, defect in the atrial septum was determined to be a patent foramen ovale. A single pulmonary trunk arose from the common arterial trunk and bifurcated to the left and right pulmonary artery, consistent with a Collet and Edwards' type I common arterial trunk with aortic predominance. Although uncommon, congenital cardiac defects should be considered in animals presenting with clinical signs of hypoxemia, dyspnea, or failure to thrive.
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Martin BJ, Ross DB, Alton GY, Joffe AR, Robertson CMT, Rebeyka IM, Atallah J. Clinical and Functional Developmental Outcomes in Neonates Undergoing Truncus Arteriosus Repair: A Cohort Study. Ann Thorac Surg 2016; 101:1827-33. [PMID: 26952297 DOI: 10.1016/j.athoracsur.2015.10.114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 09/19/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Truncus arteriosus (TA) is an uncommon congenital cardiac lesion that portends an exceedingly poor prognosis if not repaired. The objective of this study was to assess the clinical and developmental outcomes in a prospective cohort of patients who underwent TA repair. METHODS All patients who underwent a TA repair between 1996 and 2012 were included. Follow-up clinical, neurologic, and developmental data were obtained from the Western Canadian Complex Pediatric Therapies Follow-up Program database. Functional developmental outcomes were assessed at 21.1 ± 2.5 months of age with the Adaptive Behavior Assessment System-II, General Adaptive Composite (GAC) score. Survival and outcomes were compared between those with and without chromosomal abnormalities (CA). Survival and freedom from reintervention were assessed by Kaplan-Meier analysis. RESULTS The study comprised 36 infants (19 male). CA was identified in 13, with 22q11.2 deletion in 10 patients. Patients underwent TA repair at a median age of 10 days; 5 patients underwent concomitant interrupted arch repair. There were 8 deaths, 2 of which occurred in the hospital. The 5-year survival was 79.4%. Survival was similar between those with and without CA. At 5 years, freedom from reoperation was 77.2%. The mean GAC was higher in the patients without CA (93.6 ± 12.8 vs 76.1 ± 13.1, p = 0.0016). CONCLUSIONS Patients with surgically repaired TA continue to have significant postoperative mortality. Reoperation and cardiac catheterization are eventualities for a quarter of patients in the first 5 years of life. Functional developmental outcome in patients without CA is good, although it is significantly impaired in those with CA.
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Affiliation(s)
- Billie-Jean Martin
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - David B Ross
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Gwen Y Alton
- Pediatric Rehabilitation Outcomes Unit, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada; Pediatric Intensive Care, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Ari R Joffe
- Pediatric Intensive Care, Stollery Children's Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Charlene M T Robertson
- Pediatric Rehabilitation Outcomes Unit, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ivan M Rebeyka
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Atallah
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Naimo PS, Fricke TA, Yong MS, d'Udekem Y, Kelly A, Radford DJ, Bullock A, Weintraub RG, Brizard CP, Konstantinov IE. Outcomes of Truncus Arteriosus Repair in Children: 35 Years of Experience From a Single Institution. Semin Thorac Cardiovasc Surg 2016; 28:500-511. [DOI: 10.1053/j.semtcvs.2015.08.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/11/2022]
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Patrick WL, Mainwaring RD, Carrillo SA, Ma M, Reinhartz O, Petrossian E, Selamet Tierney ES, Reddy VM, Hanley FL. Anatomic Factors Associated With Truncal Valve Insufficiency and the Need for Truncal Valve Repair. World J Pediatr Congenit Heart Surg 2015; 7:9-15. [DOI: 10.1177/2150135115608093] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: Truncus arteriosus is a complex and heterogeneous form of congenital heart defect. Many of the risk factors from several decades ago, including late repair and interrupted aortic arch, have been mitigated through better understanding of the entity and improved surgical techniques. However, truncal valve dysfunction remains an important cause of morbidity and mortality. The purpose of this study was to evaluate the anatomic factors associated with truncal valve dysfunction and the need for truncal valve surgery. Methods: This was a retrospective review of 72 infants who underwent repair of truncus arteriosus at our institution. The median age at surgery was nine days, and the median weight was 3.1 kg. Preoperative assessment of truncal valve insufficiency by echocardiography revealed no or trace insufficiency in 30, mild in 25, moderate in 10, and severe in 7. The need for truncal valve surgery was dictated by the severity of truncal valve insufficiency. Results: Sixteen (22%) of the 72 patients undergoing truncus arteriosus repair had concomitant truncal valve surgery. Anatomic factors associated with the need for truncal valve surgery included an abnormal number of truncal valve cusps ( P < .005), presence of valve dysplasia ( P < .005), and the presence of an anomalous coronary artery pattern ( P < .005). Fifteen (94%) of the sixteen patients who underwent concomitant surgery had two or all three of these anatomic factors (sensitivity = 94%, specificity = 85%). Conclusion: This study demonstrates that the presence of specific anatomic factors was closely associated with the presence of truncal valve insufficiency and the need for concomitant truncal valve surgery. Preoperative evaluation of these anatomic factors may provide a useful tool in determining who should undergo concomitant truncal valve surgery.
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Affiliation(s)
- William L. Patrick
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
| | - Richard D. Mainwaring
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
| | - Sergio A. Carrillo
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
| | - Michael Ma
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
| | - Olaf Reinhartz
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
- Division of Pediatric Cardiac Surgery, Oakland Children’s Hospital, Oakland, CA, USA
| | - Edwin Petrossian
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
- Division of Pediatric Cardiac Surgery, Central Valley Children’s Hospital, Madera, CA, USA
| | - Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
| | - V. Mohan Reddy
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
| | - Frank L. Hanley
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
- Division of Pediatric Cardiac Surgery, Oakland Children’s Hospital, Oakland, CA, USA
- Division of Pediatric Cardiac Surgery, Central Valley Children’s Hospital, Madera, CA, USA
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Sandrio S, Rüffer A, Purbojo A, Glöckler M, Dittrich S, Cesnjevar R. Common arterial trunk: current implementation of the primary and staged repair strategies. Interact Cardiovasc Thorac Surg 2015; 21:754-60. [PMID: 26362626 DOI: 10.1093/icvts/ivv261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/11/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In this study, we report our experience on the primary and staged surgical approaches for common arterial trunk (CAT) repair. METHODS Between August 2003 and February 2015, 16 consecutive patients underwent CAT repair in our institution. Two different approaches have been followed: group 'primary repair' (PR) consists of patients suitable for straightforward CAT repair, who underwent surgery electively at 1-3 months of age (n = 13); group 'staged repair' (SR) consists of critically ill neonates with CAT and poor preoperative status or coexisting interrupted aortic arch (n = 3). They underwent staged CAT repair with aortic arch repair and right ventricular-to-pulmonary artery (RV-PA) shunt within the neonatal period, followed by an intracardiac repair later in infancy. RESULTS Median age at initial surgical treatment was 8 days (range: 7-21 days) in group SR and 34 days (range: 14-91 days) in group PR (P = 0.03). Mean Aristotle Comprehensive Complexity score was 11 ± 0.6 (range: 11-13) in group PR and 18 ± 3.1 (range: 15-21) in group SR (P < 0.01). Follow-up was completed with a median duration of 3.6 years (range: 8 months to 11 years). There was neither early nor late mortality in both groups. In group SR, the median interval to second stage surgery was 216 days (range: 216-260 days). Seven patients (54%) in group PR required reoperation for RV-PA conduit failure (n = 4), truncal valve repair/replacement (n = 2) or both (n = 1). After initial surgery, Kaplan-Meier freedom from reoperation after 1, 2 and 8 years was 77 ± 12, 68 ± 13 and 20 ± 17% in group PR, and 0% in group SR (log-rank P < 0.01). Although all patients in group SR required reoperation to complete the anatomical correction (second stage procedure), there was no surgical reintervention of truncal valve and aortic arch thereafter. CONCLUSIONS Routine elective CAT repair could be safely performed at 1-3 months of age. However, neonatal CAT repair could be associated with a higher mortality especially in the presence of an interrupted aortic arch. In such cases, a staged CAT repair seems to be associated with favourable postoperative course and improved hospital survival, despite the inevitable need for reoperation, which can be performed at a relatively low risk.
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Affiliation(s)
- Stany Sandrio
- Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - André Rüffer
- Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Martin Glöckler
- Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Robert Cesnjevar
- Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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O'Byrne ML, Yang W, Mercer-Rosa L, Parnell AS, Oster ME, Levenbrown Y, Tanel RE, Goldmuntz E. 22q11.2 Deletion syndrome is associated with increased perioperative events and more complicated postoperative course in infants undergoing infant operative correction of truncus arteriosus communis or interrupted aortic arch. J Thorac Cardiovasc Surg 2014; 148:1597-605. [PMID: 24629220 PMCID: PMC4127373 DOI: 10.1016/j.jtcvs.2014.02.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/13/2014] [Accepted: 02/03/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The effect of genotype on the outcomes of infant cardiac operations has not been well established. The purpose of the present study was to investigate the effect of 22q11.2 deletion (22q11del) on infants with truncus arteriosus communis (TA) and interrupted aortic arch (IAA) undergoing operative correction during infancy. METHODS We conducted a retrospective cohort study of all infants who had undergone operative correction of TA or IAA at the Children's Hospital of Philadelphia from 1995 to 2007, comparing the perioperative outcomes (hospital length of stay, intensive care, mechanical ventilation, risk of cardiac and noncardiac events, number of consultations, and number of discharge medications) by 22q11del status. RESULTS A total of 104 patients were studied (55 with TA and 49 with IAA), of whom 40 (38%) were 22q11del positive. The 22q11del status was unknown in 9 (7 with TA and 2 with IAA). In patients with known deletion status, those with 22q11del had a longer hospital and intensive care length of stay. Subjects with 22q11del also required more frequent operative reintervention and more consultations and were prescribed more medications at discharge. No significant difference was found in method of feeding between those with and without 22q11del at discharge. CONCLUSIONS In this study, 22q11del is associated with perioperative outcomes in infants undergoing operative correction of TA and IAA, with longer hospital stays and greater resource utilization in the perioperative period. These findings should inform counseling and risk stratification and warrant additional study to identify genotype-specific management strategies to improve outcomes.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa.
| | - Wei Yang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Aimee S Parnell
- Division of Cardiology, Department of Pediatrics, Children's Healthcare of Mississippi, University of Mississippi Medical Center, Jackson, Miss
| | - Matthew E Oster
- Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Yosef Levenbrown
- Department of Anesthesiology and Critical Care, Alfred I. duPont Hospital for Children, Wilmington, Del, and Jefferson Medical College, Philadelphia, Pa
| | - Ronn E Tanel
- Department of Pediatrics, University of California, San Francisco, School of Medicine, and Division of Pediatric Cardiology, UCSF Benioff Children's Hospital, San Francisco, Calif
| | - Elizabeth Goldmuntz
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
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Sojak V, Lugo J, Koolbergen D, Hazekamp M. Surgery for truncus arteriosus. Multimed Man Cardiothorac Surg 2014; 2012:mms011. [PMID: 24414715 DOI: 10.1093/mmcts/mms011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Truncus arteriosus (TA) is a congenital heart defect in which a common arterial trunk supplies systemic, pulmonary and coronary circulation. Associated cardiac anomalies are common. Without surgical treatment, most patients die within infancy. Various operative techniques have evolved over the past 50 years. More recently, many centres have adopted primary repair in the neonatal period or early infancy. The objective of this paper is to describe anatomy, diagnosis, natural history and the technique of operation of TA.
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Affiliation(s)
- Vladimir Sojak
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Watanabe N, Mainwaring RD, Reddy VM, Palmon M, Hanley FL. Early Complete Repair of Pulmonary Atresia With Ventricular Septal Defect and Major Aortopulmonary Collaterals. Ann Thorac Surg 2014; 97:909-15; discussion 914-5. [DOI: 10.1016/j.athoracsur.2013.10.115] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 09/30/2013] [Accepted: 10/11/2013] [Indexed: 11/30/2022]
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Yu FF, Lu B, Gao Y, Hou ZH, Schoepf UJ, Spearman JV, Cao HL, Sun ML, Jiang SL. Congenital anomalies of coronary arteries in complex congenital heart disease: diagnosis and analysis with dual-source CT. J Cardiovasc Comput Tomogr 2013; 7:383-90. [PMID: 24331934 DOI: 10.1016/j.jcct.2013.11.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/18/2013] [Accepted: 11/03/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Congenital heart diseases (CHDs) are sometimes associated with coronary artery anomalies (CAAs). Accurate preoperative evaluation of coronary artery anatomy is essential for successful surgical repair of complex CHD. OBJECTIVE The aim of this study was to evaluate the incidence of congenital CAAs in patients with complex CHD at dual-source CT. METHODS Four hundred seventeen consecutive patients with complex CHD underwent contrast-enhanced cardiac CT angiography. The results were retrospectively analyzed, including the types and incidences of CAAs in various forms of complex CHD. Each patient was analyzed independently by 2 experienced cardiovascular radiologists. Image quality of coronary arteries was assessed on a 5-point scale with 2 or less being nondiagnostic. RESULTS Thirty-five of 417 studies were nondiagnostic (8.39%). Sixty-three cases of CAA (15.11%) were detected by anomalous ostia and coronary arteries. CAA was involved in 6 of 108 patients with tetralogy of Fallot (5.56%), 18 of 84 patients with double outlet right ventricle (21.43%), 11 of 97 patients with pulmonary artery atresia (11.34%), 7 of 36 patients with transposition of the great arteries (22.22%), 15 of 41 patients with single ventricle (36.59%), 4 of 12 patients with truncus arteriosus/aortopulmonary window (33.33%), and 2 of 39 patients with interruption of the aortic arch/coarctation of the aorta (5.13%). Twenty of these were accompanied with an anomalous coronary course (31.74%). CONCLUSION Patients with complex CHD have a higher prevalence of CAAs, which should be considered before surgery. Dual-source CT is an effective technique to visualize and evaluate complex CHD.
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Affiliation(s)
- Fang-fang Yu
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Bin Lu
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
| | - Yang Gao
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhi-hui Hou
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - James V Spearman
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Hui-li Cao
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ming-li Sun
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shi-liang Jiang
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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O'Byrne ML, Mercer-Rosa L, Zhao H, Zhang X, Yang W, Cassedy A, Fogel MA, Rychik J, Tanel RE, Marino BS, Paridon S, Goldmuntz E. Morbidity in children and adolescents after surgical correction of truncus arteriosus communis. Am Heart J 2013; 166:512-8. [PMID: 24016501 DOI: 10.1016/j.ahj.2013.05.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/25/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies of outcome after operative correction of truncus arteriosus communis (TA) have focused on mortality and rates of reintervention. We sought to investigate the clinical status of children and adolescents with surgically corrected TA. METHODS AND RESULTS A cross-sectional study of subjects with TA was performed. Subjects underwent concurrent genetic testing, electrocardiogram, cardiac magnetic resonance imaging, cardiopulmonary exercise testing, and completed questionnaires assessing health status and health-related quality of life. Review of their medical history provided retrospective information on cardiac reintervention and use of medical care. Twenty-five subjects with a median age of 11.8 (8.1-18.99) years were enrolled. The prevalence of 22q11.2 deletion was 32%. Incidence of hospitalization, cardiac reintervention, and noncardiac operations was highest in the first year of life. Combined catheter-based and operative reintervention rates were 52% on the conduit and 56% on the pulmonary arteries. Right ventricular ejection fraction and end-diastolic volume were normal. Moderate or greater truncal valve insufficiency was seen in 11% of subjects, and truncal valve replacement occurred in 8% of subjects. Maximal oxygen consumption (P = .0002), maximal work (P < .0001), and forced vital capacity (P < .0001) were all lower than normal for age and sex. Physical health status and health-related quality of life were both severely diminished. CONCLUSION Patients with TA demonstrate significant comorbid disease throughout childhood, significant burden of operative and catheter-based reintervention, and deficits in exercise performance, functional status, and health-related quality of life.
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Affiliation(s)
- Michael L O'Byrne
- Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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Myers PO, Bautista-Hernandez V, del Nido PJ, Marx GR, Mayer JE, Pigula FA, Baird CW. Surgical repair of truncal valve regurgitation†. Eur J Cardiothorac Surg 2013; 44:813-20. [DOI: 10.1093/ejcts/ezt213] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Surgery for common arterial trunk has evolved over the past 30 years. Current management involves total repair during the neonatal period with excellent expected results. The presence of truncal valve insufficiency or interrupted aortic arch may increase the surgical risk for morbidity and mortality. Current therapy and management continues to evolve.
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Zhang Y, Li SJ, Yan J, Hu SS, Shen XD, Xu JP. Mid-term results after correction of type I and type II persistent truncus arteriosus in older patients. J Card Surg 2012; 27:228-30. [PMID: 22458281 DOI: 10.1111/j.1540-8191.2012.01423.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aims to analyze long-term results after correction of type I and type II truncus arteriosus in older patients operated in one institution over five years. METHODS Between 2006 and 2010, 12 patients, median age 4 years, underwent repair of truncus arteriosus. Repair with reconstruction of the right ventricular to pulmonary artery continuity was performed using a valved conduit in 12 patients. RESULTS There was no early mortality. All patients are alive with their original conduit 0.6 to 5 years after correction. No patients required reoperations for conduit dysfunction. Recent clinical examination was undertaken in all patients and they are in good condition. CONCLUSIONS Though mean age at operation was higher in this study than published results, the operation should be performed if the pulmonary vascular resistance is under 8 units.m(2) before operation.
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Affiliation(s)
- Yan Zhang
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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