Midterm Results of Truncus Arteriosus Communis Repair; A Single-Center Experience with 37 Cases

Objective: This study aims to evaluate the operative results of patients with the diagnosis of Truncus arteriosus communis(TAC).

Methods: Between January 2000 and April 2017, thirty-seven patients were operated with the diagnosis of TAC. Eleven patients (30%) had also interrupted aortic arch (IAA) anomaly. In 30 patients corrective surgery was primarily performed at a median age of 15 days (1 day to 21 years). In 6 patients a palliative procedure (pulmonary artery banding n = 2, bilateral pulmonary artery banding n = 4) was initially performed due to low birth-weight, cardiomyopathy and sepsis. Four of these patients underwent a corrective surgery as a second operation. One patient with restrictive cardiomyopathy was transplanted after palliation. One patient who had 910 g birth weight, severe truncal valve insufficiency and restrictive cardiomyopathy, received primarily heart transplantation at 6.5 months of age. One patient with uncorrected TAC and Eisenmenger syndrome was total corrected combined with reverse Pott shunt in age of 21 years. Truncal valve surgery was performed in 6 patients (18%) at the time of corrective surgery. Six patients had Di-George Syndrome (16%).

Results: In-hospital mortality was observed in 3 patients (n = 3/37, 8.1%). One patient died after palliative procedure. Two patients died after corrective surgery (n = 2/34, 5.8%). Two of three deaths had preoperative severe truncal valve pathology. Associated IAA anomaly was not a risk factor for mortality (p < 0.05). Median follow-up of survivors was 60 months (range: 5–136 months). Late mortality was not observed. Four patients (11.7%) required a reoperation due to the truncal valve dysfunction. Three of these patients had already received truncal valve repair at the time of corrective surgery. Conduit replacement is required in 12 patients (37.5%) and 14 patients (43.8%) required catheter intervention for the right ventricular outflow (RV) or for pulmonary artery (PA) stenosis at the follow-up time.

Conclusion: Early primary corrective surgery is the choice of TAC repair with low mortality rates even in patients with IAA. Severe truncal valve dysfunction is a risk factor for mortality and morbidity. In selected cases palliative procedures can be initially performed. High reoperation and catheter interventions rates for RV outflow and PA stenosis at the follow up time is still a challenging issue after TAC repair.