title: Repair of incompetent truncal valves: early and mid-term results.
abstract: OBJECTIVE
  To analyse the factors associated with in-hospital mortality and mid-term significant neoaortic valve regurgitation (AR) after truncal valve (TV) repair.
  
  
  METHODS
  Eleven children underwent TV repair at our institution from July 1999 to March 2012. All children presented significant preoperative TV regurgitation. Valve anatomy was quadricuspid in 7 (64%) patients and tricuspid in 4 (36%). The median age and weight at surgery were 29.6 (range 0.3-173.2) months and 12 (range 2.2-49) kg, respectively. Repair included bicuspidalization through the approximation of two leaflets associated with triangular resection of the opposite one (n = 2, 18%), or either bicuspidalization or tricuspidalization of the TV through excision of one leaflet and related sinus of Valsalva (n = 9, 82%). In 3 patients, repair was associated with coronary detachment before cusp removal, followed by coronary reimplantation.
  
  
  RESULTS
  In-hospital death occurred in 2 (18%) patients. Factors associated with hospital mortality were age <1 year (P = 0.05), weight <3 kg (P = 0.02) and longer cross-clamping time (P = 0.008). Follow-up was complete for all patients [median follow-up time: 52.2 (range 132.2-2.5) months]. Mid-term significant AR occurred in 4 patients (45%, moderate in 2 and severe in 2). One with severe AR underwent successful valve replacement 4 months postoperatively, leading to freedom from reintervention of 91%. Freedom from significant AR was 76.2 (33.2-93.5) and 60.9 (20.2-85.6) at 1 and 2 years, respectively. There was a trend towards longer freedom from mid-term significant AR for patients who underwent cusp removal compared with those who did not (P = 0.07).
  
  
  CONCLUSIONS
  TV repair in children can be performed safely with fairly good and durable results. Cusp removal might decrease the rate of severe AR on mid-term follow-up.
authors.affiliation: Unit of Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy. dr.gianluigiperri@gmail.com
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Perri
authors.forename: Sergio
authors.initials: S
authors.lastname: Filippelli
authors.forename: Angelo
authors.initials: A
authors.lastname: Polito
authors.forename: Duccio
authors.initials: D
authors.lastname: Di Carlo
authors.forename: Sonia B
authors.initials: SB
authors.lastname: Albanese
authors.forename: Adriano
authors.initials: A
authors.lastname: Carotti
mesh_terms: D000293:Adolescent; D001022:Aortic Valve Insufficiency / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D018618:Echocardiography, Doppler, Color; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014338:Truncus Arteriosus / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Congenital heart disease; Truncus arteriosus; Valve disease