Understanding Surgical Interventions of Truncal Valve After the Primary Surgical Repair and Related Outcomes Using the STS Congenital Heart Surgery Database

A. Bishnoi¹, J. Trivedi², B. Alsoufi³, C. Yerebakan⁴, S. R. Deshpande^5
1Children's National Medical Center, Washington DC, District of Columbia ²University of Louisville, Louisville, Kentucky ³Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, Kentucky ⁴Children’s National Medical Center, Washington, District of Columbia ⁵Children's National Medical Center, Washington, District of Columbia

Purpose: Surgical outcomes of neonatal repair of truncus arteriosus (TA) are well described. However, a portion of these children will require a reintervention on the truncal valve in the form of repair or replacement. There are no large-scale studies demonstrating the timing, type and outcomes of such interventions in children.

Methods: We used the Society of Thoracic Surgeons- Congenital Heart Surgery Database (STS-CHSD) to analyze demographics, clinical features and outcomes of truncal valve interventions in the form of repair or replacement after primary surgery. Details of repair and replacement of the truncal valve were analyzed. Simultaneous procedures at the time of the primary TA repair were excluded as were procedures on the right side of the heart. Initially we compared those undergoing repair versus replacement. Outcomes and risk factors were identified by each cohort using appropriate statistical analyses.

Results: Overall, 557 patients underwent truncal valve repair or replacement. Clinical and demographic characteristics are summarized in table 1. Procedures were categorized as truncal valvuloplasty / repair (40%), valve replacement (60%) including root replacement in 14%. Overall mortality was 5.2%. The groups undergoing repair versus replacement were significantly different; with those undergoing repair being significantly younger, smaller, compared to those undergoing replacement. (Table 1) Operative times for bypass and cross clamp were significantly shorter with repair. Since the groups were inherently different, the outcomes were not compared. Those undergoing repair had a post-operative length of stay of 6 (4-13) days, reported following complications: arrhythmia (10%), low cardiac output (7%), reoperation need (6%), respiratory failure (5%) and cardiac arrest (2%). For those undergoing replacement, post-operative length of stay was 8 (6-15) days, and complications reported were: arrhythmia (17%), low cardiac output (12%), respiratory failure (7%), bleeding (7%), reoperation need (5%) and cardiac arrest (4%). Overall, higher weight and need for mechanical ventilation pre-intervention were associated with mortality. (Figure1) Further analyses are focused on describing details of the various types of interventions and risk factors for poor outcomes by type of repair.

Conclusion: This large, multicenter study on truncal valve interventions after primary repair showed distinct cohorts undergoing truncal valve repair versus replacement early in the childhood. There is significant heterogeneity in the indications and types of repairs done. Further analysis should focus on optimal selection strategy for interventions based on the patient and the underlying substrate.

Identify the source of the funding for this research project: None