Multicenter Analysis of Truncal Valve Management and Outcomes in Children with Truncus Arteriosus

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 fo...

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Bibliographic Details
Published in:Pediatric cardiology 2020-10, Vol.41 (7), p.1473-1483
Main Authors: Bakar, Adnan M., Costello, John M., Sassalos, Peter, Amula, Venu, Buckley, Jason R., Smerling, Arthur J., Iliopoulos, Ilias, Riley, Christine M., Jennings, Aimee, Cashen, Katherine, Suguna Narasimhulu, Sukumar, Narayana Gowda, Keshava Murthy, Wilhelm, Michael, Badheka, Aditya, Slaven, James E., Mastropietro, Christopher W.
Format: Article
Language:English
Subjects:
Analysis
Cardiac Surgery
Cardiology
Child
Child, Preschool
Children's furniture
Female
Heart Valves - physiopathology
Humans
Infant
Infant, Newborn
Male
Medicine
Medicine & Public Health
Mortality
Original Article
Recurrence
Retrospective Studies
Risk assessment
Risk Factors
Severity of Illness Index
Truncus Arteriosus, Persistent - surgery
Vascular Surgery
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Summary: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.
ISSN:0172-0643
1432-1971
DOI:10.1007/s00246-020-02405-z