Truncus arteriosus mortality remains high

Jason R. Buckley

Children who undergo truncus arteriosus repair have a high risk for mortality within the first year of life, with an operative mortality rate of 7% and a late mortality rate of 6%, according to a presentation at Cardiology 2018.

In the multicenter, retrospective cohort study, researchers analyzed data from 216 children from 15 hospitals who underwent truncus arteriosus repair without concomitant arch obstruction from 2009 to 2016.

“We thought that looking at intermediate-term outcomes, particularly mortality after the operative period, as well as risk factors for reintervention (both reoperation and interventions on the right ventricle to pulmonary artery conduits that are placed during truncus arteriosus repair) would be best answered with a multicentered dataset because we could accrue a relatively large number of patients and provide longitudinal data on how these children do after going home from the hospital,” Jason R. Buckley, MD, assistant professor at the Medical University of South Carolina in Charleston, told Cardiology Today.

Patients were excluded if they had interrupted aortic arch, concomitant arch obstruction, hemitruncus or pseudotruncus. Patients were followed up for a median of 2.9 years.

At a median of 14 months, 50% of patients required at least one right ventricle to pulmonary artery conduit intervention after the initial surgery. In a multivariable analysis, patients who received Contegra (Medtronic) conduits were less likely to require right ventricle to pulmonary artery conduit intervention compared with those who received aortic and pulmonary homografts (P = .005). Risk factors for conduit intervention were smaller conduit size (P < .01) and the use of a pulmonary or aortic homograft (P = .03).

During follow-up, 13.4% of the overall study cohort died, with a median time to death after surgery of 3.3 months.

“Mortality after the operative hospitalization is significant and often happens within the first year of life,” Buckley said in an interview.

Risk factors for overall mortality were preoperative ventilation (OR = 2.4; 95% CI, 1.2-5.4), DiGeorge syndrome (OR = 2.2; 95% CI, 1.1-4.7), postoperative extracorporeal membrane oxygenation (OR = 5.3; 95% CI, 2.3-11.8) and delayed sternal closure (OR = 3.3; 95% CI, 1.1-9.8). Preoperative ventilation (P = .02) and DiGeorge syndrome (P = .03) were risk factors for late mortality, but not for operative mortality (P = .38 and P = .34, respectively).

“Perhaps we can use those risk factors for so-called ‘late mortality’ to identify high-risk patients that might benefit from increased surveillance or more frequent follow-up after they go home from their initial hospitalization,” Buckley said in an interview. – by Darlene Dobkowski

Reference:

Buckley JR, et al. Abstract 12. Presented at: Cardiology: 21st Annual Update on Pediatric and Congenital Cardiovascular Disease; Feb. 21-25, 2018; Scottsdale, Ariz.

Disclosure: Buckley reports no relevant financial disclosures.