Gellis L, Binney G, Alshawabkeh L, Lu M, Landzberg MJ, Mayer JE, Mullen MP, Valente AM, Sleeper LA, Brown DW.J Am Heart Assoc. 2020 Nov 17;9(22):e019104. doi: 10.1161/JAHA.120.019104. Epub 2020 Nov 9.PMID: 33161813 Free article.
Take Home Points:
- Independent risk factors for truncal valve interventions during long-term follow up are moderate or greater preoperative initial truncal valve regurgitation or stenosis, moderate or greater truncal valve regurgitation at discharge after initial full repair and a single coronary ostium.
- Moderate or greater truncal valve regurgitation is associated with larger truncal root z-scores at initial TA repair and during follow-up.
Commentary from Dr. Inga Voges (Kiel, Germany), section editor of Pediatric & Fetal Cardiology Journal Watch: This is a retrospective single-center study assessing risk factors for truncal valve intervention after complete repair for truncus arteriosus (TA). A large cohort of patients who underwent TA repair between 1985 and 2016 were included. The degree of truncal valve stenosis and regurgitation as well as truncal valve z-scores were recorded. Surgeries and re-interventions were documented. Early mortality (≤30 days postoperatively or before hospital
Discharge) and long-term outcomes were assessed. Primary outcomes were truncal valve intervention and mortality after discharge from initial full repair. Secondary outcomes were defined as time to any surgical reintervention and at least moderate truncal valve regurgitation.
Out of 170 patients, 22 patients died early (early mortality rate 13%). The residual 148 patients were defined as the long-term cohort (characteristics are displayed in Table 1). Median follow-up time after discharge from repair was 12.6 years. 19% of them died or underwent cardiac transplantation. 45 patients had a quadricuspid truncal valve and 73 patients had more than trivial truncal regurgitation before initial repair (Table 1).
11 patients of the long-term cohort had concomitant truncal valve repair at initial TA repair. 30 patients underwent at least one surgical intervention on the truncal valve during follow-up, 24 of them were from the group without truncal repair at initial surgery. Overall, 50 interventions on the truncal valve during follow up were performed. The cumulative incidence of any truncal valve intervention by 1, 5, 10, and 20 years was 0.7%, 5.1%, 15.6%, and 25.6%, respectively (Figure 2). The cumulative incidence of truncal valve repair and truncal valve replacement was 12.3% and 3.3%.
The following independent risk factors for truncal valve intervention were identified: moderate or greater preoperative initial truncal valve regurgitation or stenosis, moderate or greater truncal valve regurgitation at initial hospital discharge after full repair and a single coronary ostium (Table 2). The development of moderate or greater truncal valve regurgitation was associated with larger truncal root z-scores at initial TA repair and during follow-up.
In summary, this study demonstrates that truncal valve intervention during follow-up is common and that patients need a careful life-long follow up in specialized cardiac centers.