Surgical management of severe truncal insufficiency: Experience with truncal valve remodeling techniques

Background. Truncal valve insufficiency has been a significant short- and l ong-term risk factor for repair of truncus arteriosus. Recent reports have documented the virtues of truncal valve repair. The purpose of this report is to review our experience with truncal valve repair and illustrate our te chniques. Methods. Between 1995 and 2000, 8 patients had interventions for severe tru ncal valve insufficiency at primary repair (3 patients) or in conjunction w ith conduit replacement (5 patients). One neonate had truncal valve replace ment at initial repair early in the experience. The other 7 patients had tr uncal valve repair, 3 by valvar suture techniques. The remaining 4 patients had leaflet excision and annular remodeling in 3 (coronary reimplantation was required in 2) and commissure resuspension in 1 patient. Results. Trivial to mild truncal valve insufficiency is present in the pati ents who had leaflet excision and annular remodeling (n = 3) and commissure resuspension (n = 1). Of the 3 patients who had valvar suture truncal valv e repair, there was one death and 2 patients required acute valve replaceme nt. The 7 survivors are doing well 1 month to 6 years postoperatively. Conclusions. Truncal valve repair by valvar suture techniques has not been successful in our practice. Truncal valve remodeling by leaflet excision an d reduction annuloplasty is an effective method for truncal valve repair. W hen leaflet excision of a coronary sinus of Valsalva is required, coronary artery translocation can be accomplished. (C) 2001 by The Society of Thorac ic Surgeons.