Reinterventions after repair of common arterial trunk in neonates and young infants

OBJECTIVES To determine rates of reintervention after repair of common arte rial trunk in the neonatal and early infant periods. BACKGROUND With improving success in the early treatment of common arterial trunk, the need for reinterventional procedures in older children, adolesc ents and adults will become an increasingly widespread concern in the treat ment of these patients. METHODS We reviewed our experience with 159 infants younger than four month s of age who underwent complete primary repair of common arterial trunk at our institution from 1975 to 1998, with a focus on postoperative reinterven tions. RESULTS Of 128 early survivors, 40 underwent early reinterventions for pers istent mediastinal bleeding or other reasons. During a median follow-up of 98 months (range, 2 to 235 months), 121 reinterventions were performed in 8 1 patients. Actuarial freedom from reintervention was 50% at four years, an d freedom from a second reintervention was 75% at 11 years. A total of 92 c onduit reinterventions were performed in 75 patients, with a single reinter vention in 61 patients, 2 reinterventions in 11 patients and 3 reinterventi ons in 3 patients. Freedom from a first conduit reintervention was 45% at f ive years. The only independent variable predictive of a longer time to fir st conduit replacement was use of an allograft conduit at the original repa ir (p = 0.05), despite the significantly younger age of patients receiving an allograft conduit (p ( 0.001). Reintervention on the truncal valve was p erformed on 22 occasions in 19 patients, including 21 valve replacements in 18 patients and repair in 1, with a freedom from truncal valve reintervent ion of 83% at 10 years. Surgical (n = 29) or balloon (n = 12) reinterventio n for pulmonary artery stenosis was performed 41 times in 32 patients. Clos ure of a residual ventricular septal defect was required in 13 patients, al l of whom underwent closure originally with a continuous suture technique. Eight of 16 late deaths were related to reintervention. CONCLUSIONS The burden of reintervention after repair of common arterial tr unk in early infancy is high. Although conduit reintervention is inevitable , efforts should be made at the time of the initial repair to minimize fact ors leading to reintervention, including prevention of branch pulmonary art ery stenosis and residual interventricular communications. (J Am Coil Cardi ol 2000;35:1317-22) (C) 2000 by the American College of Cardiology.