Primary repair of common arterial trunk: A systematic meta-analysis of short- and long-term outcomes

Abstract

Objectives

Primary repair of the common arterial trunk is still burdened by high mortality rates. Because of the low incidence and complexity of common arterial trunk, evidence is limited to reports with small sample sizes, and issues such as the ideal surgical timing to address the primary repair are still debated. We performed a systematic review and meta-analysis to estimate the pooled mortality, morbidity, and reoperation rates after common arterial trunk primary repair.

Methods

PubMed, Google Scholar, Ovid-MEDLINE, and Ovid-EMBASE databases were searched to identify studies on common arterial trunk primary repair. Eligible studies reporting early mortality (primary outcome) after common arterial trunk primary repair were screened. Secondary outcomes were survival and reoperation on the right ventricle pulmonary artery conduit at the follow-up.

Results

Among 319 articles retrieved, 43 studies including 4844 patients met the inclusion criteria. Pooled early mortality was 11.23% (95% CI, 9.4-13.37). There was no difference in the early mortality rates between multicenter and single-center studies. The sub-analysis comparing the neonatal and non-neonatal repair groups showed a significantly lower mortality rate in the neonatal group (P < .001). At the follow-up, the pooled mortality was 0.72% per year (95% CI, 0.51-0.93) and the reoperation rate on the right ventricle pulmonary artery conduit was 3.4% per year (95% CI, 2.24-4.57).

Conclusions

The early mortality rate after common arterial trunk primary repair is relatively high, and the reoperation rate per year on the right ventricle pulmonary artery conduit is a major problem. This meta-analysis supports the current tendency of performing primary repair during the neonatal period and can serve as a benchmark for future studies.