title: Common arterial trunk: current implementation of the primary and staged repair strategies.
abstract: OBJECTIVE
  In this study, we report our experience on the primary and staged surgical approaches for common arterial trunk (CAT) repair.
  
  
  METHODS
  Between August 2003 and February 2015, 16 consecutive patients underwent CAT repair in our institution. Two different approaches have been followed: group 'primary repair' (PR) consists of patients suitable for straightforward CAT repair, who underwent surgery electively at 1-3 months of age (n = 13); group 'staged repair' (SR) consists of critically ill neonates with CAT and poor preoperative status or coexisting interrupted aortic arch (n = 3). They underwent staged CAT repair with aortic arch repair and right ventricular-to-pulmonary artery (RV-PA) shunt within the neonatal period, followed by an intracardiac repair later in infancy.
  
  
  RESULTS
  Median age at initial surgical treatment was 8 days (range: 7-21 days) in group SR and 34 days (range: 14-91 days) in group PR (P = 0.03). Mean Aristotle Comprehensive Complexity score was 11 ± 0.6 (range: 11-13) in group PR and 18 ± 3.1 (range: 15-21) in group SR (P < 0.01). Follow-up was completed with a median duration of 3.6 years (range: 8 months to 11 years). There was neither early nor late mortality in both groups. In group SR, the median interval to second stage surgery was 216 days (range: 216-260 days). Seven patients (54%) in group PR required reoperation for RV-PA conduit failure (n = 4), truncal valve repair/replacement (n = 2) or both (n = 1). After initial surgery, Kaplan-Meier freedom from reoperation after 1, 2 and 8 years was 77 ± 12, 68 ± 13 and 20 ± 17% in group PR, and 0% in group SR (log-rank P < 0.01). Although all patients in group SR required reoperation to complete the anatomical correction (second stage procedure), there was no surgical reintervention of truncal valve and aortic arch thereafter.
  
  
  CONCLUSIONS
  Routine elective CAT repair could be safely performed at 1-3 months of age. However, neonatal CAT repair could be associated with a higher mortality especially in the presence of an interrupted aortic arch. In such cases, a staged CAT repair seems to be associated with favourable postoperative course and improved hospital survival, despite the inevitable need for reoperation, which can be performed at a relatively low risk.
authors.affiliation: Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany s.p.sandrio@googlemail.com stany.sandrio@uk-erlangen.de.
authors.forename: Stany
authors.initials: S
authors.lastname: Sandrio
authors.affiliation: Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Rüffer
authors.affiliation: Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Ariawan
authors.initials: A
authors.lastname: Purbojo
authors.affiliation: Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Glöckler
authors.affiliation: Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Dittrich
authors.affiliation: Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Cesnjevar
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014339:Truncus Arteriosus, Persistent / Q000601:surgery*
keywords: Congenital heart disease; Interrupted aortic arch; Truncus arteriosus