Abstract 12405: Up to 39 Years of Follow-up After Repair of Truncus Arteriosus
Backgrounds: Long-term results of Rastelli operation for truncus arteriosus remain undetermined.
Methods: At our institute, 55 Rastelli operations were performed for truncus arteriosus from1974 to 2002. Retrospective review of medical records was performed to assess long-term outcomes among 35 patients who survived the initial repair. The median age at the initial operation was 2.7 months, with the median body weight of 3.8 kg. In most cases, conduit made of equine pericardium with hand-made valve of either equine or autologous pericardium was used at the initial operation. Before the initial operation, truncal valve regurgitation was noted as follows: none (79%), mild (6%), moderate (15%), and severe (0%).
Results: Mean age at the last follow-up was 22 years old, ranging 9.6 to 43 years. Mean follow-up duration was 21 years, ranging 9.4 to 39 years. There was only one late death, which was due to cerebral hemorrhage. Actuarial survival rate was 100% at 10 years, 95% at 20 years, and 95% at 30 years after the initial operation. Freedom from catheter interventions for conduit and pulmonary artery stenosis was 75% at 10 years and 60% at 15 years after the initial operation. All patients except 2 had undergone conduit reoperations during follow-up, and more than two times of reoperations had been performed in 30%. Freedom from conduit reoperation was 50% at 5 years and 10% at 15 years after the initial operation. Freedom from truncal valve replacement was 80% at 10 years, 70% at 20 years, and 70% at 30 years after the initial operation. In patients with moderate truncal valve regurgitation, freedom from truncal valve replacement was 30% at 10 years, which was lower than that (90%) in patients with no-mild truncal valve regurgitation. At the time of follow-up, 97% of patients were in NYHA functional class I or II. 40% of patients had full-time job, 37% were students, and 20% were unemployed.
Conclusions: Although multiple catheter interventions and re-do operations for conduit stenosis and pulmonary artery stenosis are required in almost all survivors of the initial repair, long-term survival and NYHA functional class are good. Truncal valve replacement may be required, especially in patients with significant truncal valve regurgitation before operation.
- © 2012 by American Heart Association, Inc.