Early and midterm results of an alternative procedure to homografts in primary repair of truncus arteriosus communis.
BACKGROUND
Repair of truncus arteriosus communis (TAC) in the neonatal and early infant period has become a standard practice. We report our experience on primary repair of TAC with a bovine pericardial-valved woven Dacron conduit as an alternative procedure to homografts, with a focus on early and midterm results.


METHODS
From January 2001 to December 2007, 15 patients with mean age 1.5 years (range 3 months to 8 years), underwent primary repair of simple TAC. Cases with cardiogenic shock, complex-associated cardiac lesions, or adverse anatomy of the truncal valve were excluded. The Collett and Edwards anatomical type classification of TAC was as follows: type I, 13 (87%); and type II, 2 (13%). Right ventricular outflow tract was reconstructed in all the cases with a bovine pericardial-valved woven Dacron conduit.


RESULTS
Overall mortality was 6.6% (1 death due to severe pulmonary hypertension). At a mean follow-up of 31 months (range 6-51), there were no deaths (5-year actuarial survival 93.4%). Out of the 14 midterm survivors, three developed stenosis of the pericardial-valved woven Dacron conduit, but only one underwent interventional procedure including percutaneous balloon dilation with stenting for associated left pulmonary artery hypoplasia. The rate of patients with no surgical or percutaneous reinterventions performed because of obstruction of the right ventricular outflow tract reconstruction in the midterm (5 years) was 86%.


CONCLUSIONS
Truncus arteriosus communis repair with a bovine pericardial-valved woven Dacron conduit can be performed with a very low perioperative mortality and satisfactory midterm morbidity, favorably compared with that reported for the use of homografts. Interventional cardiac catheterization may delay the time of reoperation for inevitable conduit replacement due to stenosis.
Curi-Curi
Pedro
P
Department of Pediatric Cardiac Surgery and Congenital Heart Disease, Ignacio Chavez National Cardiology Institute of México, Mexico City, Mexico. pcuricuri@gmail.com
Cervantes
Jorge
J
Soulé
Mauricio
M
Erdmenger
Julio
J
Calderón-Colmenero
Juan
J
Ramírez
Samuel
S
D000800:Angioplasty, Balloon / Q000295:instrumentation; D000818:Animals; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008800:Mexico; D010496:Pericardium / Q000637:transplantation*; D011093:Polyethylene Terephthalates; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014338:Truncus Arteriosus / Q000002:abnormalities / Q000601:surgery*
D011093:Polyethylene Terephthalates