Prognosis of operated truncus: A single-center experience

Introduction

Common arterial trunk (CAT), a rare congenital cardiovascular anomaly characterized by a single arterial vessel originating from the heart that supplies systemic, pulmonary, and coronary circulations, accounts for 0.3–1% of congenital heart defects. Without early surgical correction, this lesion leads to progressive heart failure and irreversible pulmonary hypertension.

Method

A retrospective, longitudinal cohort analysis was conducted on 25 patients who underwent CAT repair at La Rabta University Hospital's Pediatric Cardiology Department (1983–2016). Data included preoperative diagnostics (transthoracic echocardiography, cardiac catheterization, CT angiography), surgical details, and postoperative follow-up (median: 16 years). Outcomes were analyzed using Kaplan-Meier survival curves and descriptive statistics.

Results

Cohort characteristics: Median age at admission: 60 days (IQR: 185 days; range: 1 day–6 years). Diagnostic concordance: Echocardiography confirmed CAT in 100% of cases, with anatomical subtype identification in 64% (16/25); advanced imaging (CT/catheterization) was required for 36% (9/25). Surgical intervention: Median age at repair: 14.16 months (range: 1–108 months). Anatomical concordance between imaging and intraoperative findings: 80%. Early outcomes: In-hospital mortality: 4% (1/25; septic shock). Major complications included truncal valve insufficiency (80%), cardiogenic shock (40%), nosocomial infection (40%), and severe pulmonary hypertension (28%). Long-term survival: Overall survival at 5 years: 87.5%. Late mortality: 24% (6/25; mean age: 9.5 years), predominantly cardiac-related (66.7%). Reinterventions: 44% (11/25) required reoperations (median follow-up: 16 years). Freedom from reintervention: 50% at 10 years. Primary indications: right ventricle-pulmonary artery conduit degeneration (44%), severe pulmonary insufficiency (16%), aortic valve dysfunction (11%), and infective endocarditis (5%).

Conclusion

Complete CAT repair confers excellent medium- and long-term survival, yet reinterventions—primarily for conduit degeneration and valvular dysfunction—remain inevitable. These findings underscore the necessity for lifelong surveillance and highlight the durability challenges of current surgical conduits.