A twenty year experience of surgery for truncus arteriosus – improved outcomes are not related to younger age at operation

  • Dr Levi Bassin, The Children's Hospital at Westmead, Sydney., Australia
  • Mr Andrew Cole, The Children's Hospital at Westmead, Sydney., Australia
  • A/Prof Gary Sholler, The Children's Hospital at Westmead, Sydney., Australia
  • Dr Ian Nicholson, The Children's Hospital at Westmead, Sydney., Australia
  • A/Prof Richard Chard, The Children's Hospital at Westmead, Sydney., Australia
  • A/Prof David Winlaw, The Children's Hospital at Westmead, Sydney., Australia

    • INTRODUCTION: The approach to repair of truncus arteriosus (TA) has changed over the last 20 years, with most units now preferring to operate in the neonatal period. There is a perception that the older patients did better after surgery although delaying operation risks consequences of heart failure. Refinement of perioperative practice and a tendency to now homografts rather than Hancock and non valved conduits also complicate analysis of outcomes.

    METHODS: We assessed the impact of these factors in our single-institution historical cohort. 73 consecutive patients underwent repair of TA (n=66) or hemitruncus (n=7) between 1986 and 2005. Interrupted aortic arch was present in 6. Era 1 (n=37) was 1985 – 1993, era 2 (n=36) was 1993–2005.

    RESULTS: Follow up was complete in 63. There were 21 perioperative deaths (30 day), 28%, in the entire cohort with 3 late deaths. Early mortality was 16/37(43%) in era 1 vs 5/36 (14%) in era 2 (p < 0.05). The was no difference in age at operation between eras (34 and 28d, range 0 – 2.6y) although the median age of those that died was 15d vs survivors at 34d (p=ns). Time to first conduit replacement was 3.4 years for the entire group and was not influenced by conduit choice.

    DISCUSSION: Survival in neonates undergoing repair of TA improved significantly between eras. Numerous factors may explain this improvement but age at operation and choice of RV-PA conduit do not explain this difference. Neonatal repair with a homograft RV-PA connection remains our current approach.