{"title":"A 30 year experience of truncus arteriosus repair at a single institution: usefulness of staged approach for complicated lesions.","authors":"Yusuke Ando, Toshihide Nakano, Akinori Hirano, Takeaki Harada, Ryusuke Hosoda, Keisuke Iwahashi, Hideaki Kado","doi":"10.1007/s11748-025-02134-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Primary repair is currently preferred for truncus arteriosus, however, staged repair may be useful when the lesion is complex. This study aimed to compare the mortality and reoperation rates of primary versus staged repair.</p><p><strong>Methods: </strong>Nineteen patients undergoing primary repair and 30 undergoing staged repair between 1991 and 2021 were reviewed. The main indications for staged repair were moderate or greater truncal valve insufficiency, arch obstruction, and low weight (< 2.5 kg).</p><p><strong>Results: </strong>The staged group included more patients with moderate or greater truncal valve insufficiency (primary vs staged, 11 vs 53%, P = 0.001) and more small patients (median, 3.4 kg vs 2.8 kg, P = 0.002). In the staged group, 26 patients (87%) achieved definitive repair with a median weight of 6.3 kg. The 15 year survival rate after initial surgery was 90% in the primary group and 90% in the staged group (P = 0.906). In patients with moderate or greater truncal valve insufficiency or arch obstruction, the survival rate was higher in the staged group than in the primary group (P = 0.024). There was no difference in the cumulative incidence of reoperation on the right ventricular outflow tract (72 vs 72% at 15 years, P = 0.448) or pulmonary artery branches (20 vs 38% at 15 years, P = 0.179).</p><p><strong>Conclusions: </strong>Truncus arteriosus can now be treated with low mortality risk. In patients with complex lesions, the use of a staged approach may yield similar results as in patients without complex lesions.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1000,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"General Thoracic and Cardiovascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11748-025-02134-1","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: Primary repair is currently preferred for truncus arteriosus, however, staged repair may be useful when the lesion is complex. This study aimed to compare the mortality and reoperation rates of primary versus staged repair.
Methods: Nineteen patients undergoing primary repair and 30 undergoing staged repair between 1991 and 2021 were reviewed. The main indications for staged repair were moderate or greater truncal valve insufficiency, arch obstruction, and low weight (< 2.5 kg).
Results: The staged group included more patients with moderate or greater truncal valve insufficiency (primary vs staged, 11 vs 53%, P = 0.001) and more small patients (median, 3.4 kg vs 2.8 kg, P = 0.002). In the staged group, 26 patients (87%) achieved definitive repair with a median weight of 6.3 kg. The 15 year survival rate after initial surgery was 90% in the primary group and 90% in the staged group (P = 0.906). In patients with moderate or greater truncal valve insufficiency or arch obstruction, the survival rate was higher in the staged group than in the primary group (P = 0.024). There was no difference in the cumulative incidence of reoperation on the right ventricular outflow tract (72 vs 72% at 15 years, P = 0.448) or pulmonary artery branches (20 vs 38% at 15 years, P = 0.179).
Conclusions: Truncus arteriosus can now be treated with low mortality risk. In patients with complex lesions, the use of a staged approach may yield similar results as in patients without complex lesions.
目的:目前首选动脉干修复,然而,当病变复杂时,分期修复可能是有用的。本研究旨在比较初级修复与分期修复的死亡率和再手术率。方法:回顾性分析1991年至2021年间19例初次修复患者和30例分期修复患者的临床资料。分阶段修复的主要适应症是中度或更严重的截断瓣不全、弓阻和体重过轻(结果:分阶段组包括更多的中度或更严重的截断瓣不全患者(原发性vs分期,11% vs 53%, P = 0.001)和更多的小患者(中位数,3.4 kg vs 2.8 kg, P = 0.002)。在分阶段组中,26例(87%)患者获得了最终修复,中位体重为6.3 kg。首发组术后15年生存率为90%,分期组术后15年生存率为90% (P = 0.906)。在中度或重度瓣膜不全或弓阻的患者中,分期组的生存率高于原发性组(P = 0.024)。在右心室流出道(72 vs 72%, 15年,P = 0.448)或肺动脉分支(20 vs 38%, 15年,P = 0.179)的累计再手术发生率无差异。结论:动脉干治疗死亡率低。对于复杂病变的患者,分期入路的使用可能会产生与无复杂病变患者相似的结果。
期刊介绍:
The General Thoracic and Cardiovascular Surgery is the official publication of The Japanese Association for Thoracic Surgery and The Japanese Association for Chest Surgery, the affiliated journal of The Japanese Society for Cardiovascular Surgery, that publishes clinical and experimental studies in fields related to thoracic and cardiovascular surgery.