Repair of the truncal valve and associated interrupted arch in neonates with truncus arteriosus

Objective: Truncal valve regurgitation and interrupted aortic arch have fre quently been identified as risk factors in the repair of truncus arteriosus , We wished to examine these factors in the current era including the impac t of truncal valve repair. Methods: Between January 1992 and August 1998, 5 0 patients underwent surgical repair of truncus arteriosus. Their ages rang ed from 2 days to 6 months (median, 2 weeks). Nine patients had associated interrupted aortic arch. Of the 14 patients (28%) in whom truncal valve reg urgitation was diagnosed preoperatively, 5 had mild regurgitation, 5 had mo derate regurgitation, and 4 had severe regurgitation. Five underwent trunca l valve repair and 1 underwent homograft replacement of the truncal valve w ith coronary reimplantation. Results: The actuarial survival was 96% at 30 days, 1 year, and 3 years. There were no deaths in patients with associated interrupted aortic arch. The 2 deaths in the series occurred in patients w ith truncal valve regurgitation, neither of whom underwent repair, Postoper ative transthoracic echocardiography in patients who underwent valve repair showed minimal residual valvular regurgitation, None of the patients has r equired reoperation because of truncal valve problems or aortic arch stenos is at a median follow-up of 23 months (range, 1-60 months). Conduit replace ment has been done in 17 patients (34%) after a mean duration of 2 years. T he freedom from reoperation for those who had an aortic homograft was 4 yea rs and for those who had a pulmonary homograft was 3 years. Conclusion: Des pite the magnitude of the operation, excellent results can be achieved in c omplex forms of truncus arteriosus. In the current era interrupted aortic a rch is no longer a risk factor for repair of truncus. Aggressive applicatio n of truncal valvuloplasty methods should neutralize the traditional risk f actor of truncal valve regurgitation.