Truncus Arteriosus And Truncal Valve Insufficiency: What Matters?
Paige E. Brlecic, MD, Carlos Bonilla-Ramirez, MD, Neil Cambronero, MD, Ziyad M. Binsalamah, MD FRCSC, Iki Adachi, MD, Edward J. Hickey, MD, Michiaki Imamura, Md PhD, Jeffrey S. Heinle, MD, Christopher A. Caldarone, MD.
Baylor College of Medicine, Houston, TX, USA.
Objective(s): Truncus arteriosus is associated with high mortality and reintervention rates. We studied the proportion of patients with truncal valve (TV) insufficiency (TVI), their disease severity, and associated outcomes after truncus arteriosus repair (TAR).
Methods: 107 patients underwent TAR at our institution from 1995 to 2019, of which 65% (69) were diagnosed with TVI. TVI, identified on pre- and post-TAR echocardiography, was characterized as none, mild, moderate, or severe. We studied the association between TVI and mortality/(re)interventions using Kaplan-Meier analyses.
Results: Of 69 patients with TVI, 61% (42) had mild, 35% (24) moderate, and 4% (3) severe disease pre-TAR. Moderate/severe TVI post-TAR were associated with reduced survival (p<0.0011). 22 (21%) patients underwent concomitant TV-intervention, of these 18% (4) had none/mild, 73% (16) moderate, and 9% (2) severe pre-TAR TVI. 55% (12) required repeat TV-intervention. Among moderate/severe pre-TAR TVI, concomitant TV-intervention did not reduce the need for repeat TV-intervention (p=0.7) or mortality (p=0.9). 21 (20%) patients overall underwent subsequent (43% [9]) or repeat (57% [12]) TV intervention. Moderate and severe TVI (both pre-TAR, p<0.0001/post-TAR, p<0.0001) as well as quadricuspid TV (p=0.0034) were associated with increased subsequent or repeat TV-interventions. 78% (14/18) of patients with moderate/severe pre-TAR TVI and quadricuspid TV required intervention.
Conclusions: Patients with moderate/severe TVI have higher mortality (post-TAR TVI) and reintervention rates (pre-/post-TAR TVI). The durability of concomitant TV-intervention in moderate/severe TVI has scope for improvement. Patients with quadricuspid TV and moderate/severe TVI (pre-TAR) are likely to require TV-intervention and should be considered at time of TAR repair.
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