title: Surgical repair of truncal valve regurgitation.
abstract: OBJECTIVE
  Truncal valve regurgitation remains a short- and long-term risk factor for patients with truncus arteriosus. There are limited data available on techniques and outcomes of truncal valve repair (TVR). The aim of this study was to report our experience with TVR in patients of all ages.
  
  
  METHODS
  From 1997 to 2012, 36 patients (13 neonates, 30 children and 3 adults) underwent TVR for significant regurgitation.
  
  
  RESULTS
  There were 3 early deaths (8%), all of which were in neonates. Twenty-two patients had a quadricuspid, 13 a tricuspid and 1 a bicuspid truncal valve before repair. Valve repair improved regurgitation in 31 of 36 repairs. The median regurgitation decreased from moderate-severe to mild (P < 0.001). During a mean follow-up of 38.3 ± 44.9 months (range 1 month-15 years), there was 1 late death, 16 patients required reoperation on the truncal valve and 1 required a second reoperation. Freedom from reoperation was 91.4 ± 4.8% at 1 year, 55.0 ± 10.4% at 5 and 22.9 ± 12.2% at 10 years. A quadricuspid valve after repair tended to worsen freedom from reoperation (P = 0.15), and tricuspidization tended to improve freedom from reoperation (P = 0.19). Neonatal repair (hazards ratio (HR) 4.1, P = 0.03) and leaflet thinning (HR 22.5, P = 0.002) were independent predictors of reoperation.
  
  
  CONCLUSIONS
  Valve repair for truncal valve regurgitation is feasible, with good results. Surgical creation of a tricuspid truncal valve seems to provide the best outcomes in this challenging population.
authors.affiliation: Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA.
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Myers
authors.forename: Victor
authors.initials: V
authors.lastname: Bautista-Hernandez
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: del Nido
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Marx
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pigula
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Baird
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014339:Truncus Arteriosus, Persistent / Q000601:surgery*
keywords: Truncal valve regurgitation; Truncal valve repair; Truncus arteriosus; Valve repair