Durability of truncal valve repair.
BACKGROUND
Truncus arteriosus associated with truncal valve dysfunction has been shown to increase the mortality and morbidity associated with repair and the various techniques employed for truncal valve repair continue to evolve. We sought to examine the durability of truncal valve repair in truncus arteriosus.


METHODS
We reviewed all patients who underwent truncal valve repair at our institution from 1995 to 2008. Repair techniques included leaflet delamination, bicuspidization, commissuroplasty, annuloplasty, and leaflet augmentation. We examined long-term valve durability, function and need for valve replacement.


RESULTS
A total of 17 patients underwent truncal valve repair, including 3 for predominant stenosis (>70 mm Hg gradient), 2 for mixed moderate stenosis (40 mm Hg gradient) and moderate regurgitation, and 12 for moderate or greater regurgitation. Of these, 14 patients (14 of 17, 82%) underwent valvuloplasty at the time of the initial truncus arteriosus repair. The median age at truncal valve repair was 24 days (range, 4 days to 42 years). Thirteen patients had 1 valvuloplasty, 3 patients had 2 valvuloplasties, and 1 patient had 3 valvuloplasties before undergoing a prosthetic valve replacement at age 13 years. Actuarial freedom from repeat truncal valve operation was 70% at 5 years and 50% at 7 years. Freedom from truncal valve replacement was 100% at 10 years. To date, only 1 patient (6%) has required a prosthetic valve. Echocardiography at 48 ± 33 (mean ± SD) months postoperatively showed a peak gradient of 11 ± 13 mm Hg; 6 patients have moderate regurgitation, and the rest have mild or less regurgitation.


CONCLUSIONS
Truncal valve repair is a durable option with an acceptable reoperation rate, good function, and a low likelihood of needing truncal valve replacement. This is one of the largest series of truncal valve repairs and emphasizes that valve repair should remain the primary option.
Kaza
Aditya K
AK
Division of Pediatric Cardiothoracic Surgery, University of Utah School of Medicine and Primary Children's Medical Center, Salt Lake City, Utah, USA. ak.kaza@hsc.utah.edu
Burch
Phillip T
PT
Pinto
Nelangi
N
Minich
L Luann
LL
Tani
Lloyd Y
LY
Hawkins
John A
JA
D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D014339:Truncus Arteriosus, Persistent / Q000000981:diagnostic imaging / Q000601:surgery*; D014463:Ultrasonography; D055815:Young Adult