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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 1057-1065, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
EL Bove, FM Lupinetti, AK Pridjian, RH Beekman 3d, LB Callow, AR Snider and A Rosenthal
Although the early mortality for repair of truncus arteriosus has decreased
in the modern era, routine correction in the neonate has not been widely
adopted. To assess the results of our protocol of early repair, we reviewed
46 neonates and infants undergoing repair of truncus arteriosus at the
University of Michigan Medical Center from January 1986 to January 1992.
Their ages ranged from 1 day to 7 months (median 13 days) and weights from
1.8 kg to 5.4 kg (mean 3.1 kg). Repair was performed beyond the first month
of life in only 8 patients, because of late referral in 7 and severe
noncardiac problems in 1. Associated cardiac anomalies were frequently
encountered, the most common being interrupted aortic arch (n = 5),
nonconfluent pulmonary arteries (n = 4), hypoplastic pulmonary arteries (n
= 4), and major coronary artery anomalies (n = 3). Truncal valve
replacement was performed in 5 patients with severe regurgitation, 3 of
whom also had truncal valve systolic pressure gradients of 30 mm Hg or
more. The truncal valve was replaced with a mechanical prosthesis in 2
patients and with a cryopreserved homograft in 3 patients. Right ventricle-
pulmonary artery continuity was established with a homograft in 41 patients
(range 8 mm to 15 mm), a valved heterograft conduit in 4 (range 12 mm to 14
mm), and a nonvalved polytetrafluoroethylene tube in the remaining patient
(8 mm). There were 5 hospital deaths (11%, 70% confidence limits 7% to
17%). Multivariate and univariate analyses failed to demonstrate a
relationship between hospital mortality and age, weight, or associated
cardiac anomalies. Only 1 death occurred among 9 patients with interrupted
aortic arch or nonconfluent pulmonary arteries. Hospital survivors were
followed-up from 3 months to 6.3 years (mean 3 +/- 0.4 years). Late
noncardiac deaths occurred in 3 patients, all within 4 months after the
operation. Actuarial survival was 81% +/- 6% at 90 days and beyond. Despite
the prevalence of major associated conditions, early repair has resulted in
excellent survival. We continue to recommend repair promptly after
presentation, optimally within the first month of life.
ARTICLES
Results of a policy of primary repair of truncus arteriosus in the neonate
Department of Surgery, University of Michigan School of Medicine, Ann Arbor.
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S. Nakae, S. Kasahara, N. Kuroyama, Z.-B. Lin, S. Hiraishi, Y. Agata, and H. Yoshimura Correction of Truncus Arteriosus With Autologous Arterial Flap in Neonates and Small Infants Ann. Thorac. Surg., July 1, 1996; 62(1): 123 - 128. [Abstract] [Full Text]
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F. L. Hanley Invited Commentary Ann. Thorac. Surg., July 1, 1996; 62(1): 129 - 129. [Full Text]
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F. Lacour-Gayet, A. Serraf, T. Komiya, M. Sousa-Uva, J. Bruniaux, A. Touchot, D. Roux, P. Neuville, and C. Planche TRUNCUS ARTERIOSUS REPAIR: INFLUENCE OF TECHNIQUES OF RIGHT VENTRICULAR OUTFLOW TRACT RECONSTRUCTION J. Thorac. Cardiovasc. Surg., April 1, 1996; 111(4): 849 - 856. [Abstract] [Full Text]
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