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Outcomes after common arterial trunk repair: Impact of the surgical technique.
- Source :
-
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2021 Oct; Vol. 162 (4), pp. 1205-1214.e2. Date of Electronic Publication: 2020 Nov 28. - Publication Year :
- 2021
-
Abstract
- Objectives: We compared the risk of mortality and reintervention after common arterial trunk (CAT) repair for different surgical techniques, in particular the reconstruction of the right ventricle outflow tract with left atrial appendage (LAA) without a monocusp.<br />Methods: The study population comprised 125 patients with repaired CAT who were followed-up at our institution between 2000 and 2018. Statistical analysis included Cox proportional hazard models.<br />Results: Median follow-up was 10.6 years. The 10-year survival rate was 88.2% (95% confidence interval [CI], 80.6-92.4) with the poorest outcome for CAT type IV (64.3%; 95% CI, 36.8-82.3; P < .01). In multivariable analysis, coronary anomalies (hazard ratio [HR], 11.63 [3.84-35.29], P < .001) and CAT with interrupted aortic arch (HR, 6.50 [2.10-20.16], P = .001) were substantial and independent risk factors for mortality. Initial repair with LAA was not associated with an increased risk of mortality (HR, 0.37 [0.11-1.24], P = .11). The median age at reintervention was 3.6 years [7.3 days-13.1 years]. At 10 years, freedom from reintervention was greater in the group with LAA repair compared with the valved conduit group, 73.3% (95% CI, 41.3-89.4) versus 17.2% (95% CI, 9.2-27.4) (P < .001), respectively. Using a valved conduit for repair (HR, 4.79 [2.45-9.39], P < .001), truncal valve insufficiency (HR, 2.92 [1.62-5.26], P < .001) and DiGeorge syndrome (HR, 2.01 [1.15-3.51], P = .01) were independent and clinically important risk factors for reintervention.<br />Conclusions: For the repair of CAT, the LAA technique for right ventricle outflow tract reconstruction was associated with comparable survival and greater freedom from reintervention than the use of a valved conduit.<br /> (Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Atrial Appendage diagnostic imaging
Atrial Appendage surgery
Child
France epidemiology
Heart Ventricles diagnostic imaging
Heart Ventricles surgery
Humans
Infant, Newborn
Male
Mortality
Outcome and Process Assessment, Health Care
Risk Adjustment methods
Risk Factors
Truncus Arteriosus, Persistent diagnosis
Truncus Arteriosus, Persistent mortality
Truncus Arteriosus, Persistent physiopathology
Cardiovascular Surgical Procedures adverse effects
Cardiovascular Surgical Procedures instrumentation
Cardiovascular Surgical Procedures methods
Coronary Vessel Anomalies epidemiology
Coronary Vessel Anomalies surgery
Postoperative Complications diagnosis
Postoperative Complications epidemiology
Postoperative Complications surgery
Reoperation methods
Reoperation statistics & numerical data
Truncus Arteriosus, Persistent surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1097-685X
- Volume :
- 162
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 33342576
- Full Text :
- https://doi.org/10.1016/j.jtcvs.2020.10.147