Neonatal repair of truncus arteriosus: Continuing improvement in outcomes

Background. Repair of truncus arteriosus in the neonatal and early infant p eriods has become standard practice at many centers. We reviewed our recent experience with repair of truncus arteriosus in neonates, with a focus on early and intermediate outcomes. Methods. From July 1992 to December 1999, 65 patients 1 month of age or les s underwent primary complete repair of truncus arteriosus. Median age was 1 0 days, and median weight was 3.2 kg. Major associated anomalies included m oderate or severe truncal valve regurgitation in 15 patients (23%), interru pted aortic arch in 8 (12%), coronary artery abnormalities in 12 (18%), and nonconfluence of the pulmonary arteries in 3 (5%). Median durations of car diopulmonary bypass and cardioplegic arrest were 172 minutes and 90 minutes , respectively. Circulatory arrest was employed only in 7 patients undergoi ng concomitant repair of interrupted arch. Reconstruction of the right vent ricular outflow tract was achieved with an aortic (n = 39) or pulmonary (n = 26) allograft valved conduit (median diameter, 12 mm). Replacement (n = 6 ) or repair (n = 5) of a regurgitant truncal valve was performed in 11 pati ents, and interrupted arch was repaired in 8. Results. There were three early deaths (5%). Early reoperations included re exploration for bleeding in 3 patients, emergent replacement of a pulmonary outflow conduit that failed acutely in 1 patient, and placement of a perma nent pacemaker in 1. Mechanical circulatory support was required in 1 patie nt. During the median follow-up of 32 months, there were two deaths. The Ka plan-Meier estimate of survival was 92% at 1 year and beyond. The only demo graphic, diagnostic, or operative factors significantly associated with poo rer survival over time were operative weight of 2.5 kg or less (p = 0.01) a nd truncal valve replacement (p = 0.009). Actuarial freedom from conduit re placement among early survivors was 57% at 3 years. Conclusions. Repair of truncus arteriosus in the neonatal period can be per formed routinely with excellent survival, even in patients with major assoc iated abnormalities. (C) 2001 by The Society of Thoracic Surgeons.