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OBJECTIVES. The impact of truncal valve (TV) on long-term evolution after truncus arteriosus (TA) repair remains poorly defined. The purpose of this report was to analyze how TV influences the management of TA and its outcome.
METHODS. From January 1988 to December 2003, 153 patients underwent complete repair of TA. Median age was 35 days (range: 3- 495). Pre-operative TV insufficiency was severe in 9 (6%). TV was quadricuspid in 36 patients (24 %).
RESULTS. Median follow up of 87 months (range: 3-210) was achieved in all survivors. The actuarial survival rates were 79.5+/-3.2% and 78.7+/-3.3% at 1 and 15 years respectively. Nine patients underwent TV plasty or replacement at initial procedure, four died early. Among 85 patients, 19 (22%) underwent associated (n=18) or not (n=5) TV reoperation in a median delay of 68 months (range 2-201): 19 replacement, 2 plasties and 2 Bentall procedure were performed with 2 deaths.1, 10 and 15 years freedom from TV reoperation rates were 96 %, 81.5% and 53.8% respectively. At last visit, 3 patients present severe TV insufficiency.Statistical analysis revealed that initial TV plasty or replacement were risk factors for mortality (p=0.0084).Severe initial TV insufficiency (p=0.0042) and quadricuspid TV (p=0.0032) were risk factors for TV reoperation or late severe TV insufficiency but didn't affect overall mortality.
CONCLUSIONS. Significant poorer survival was associated with initial TV plasty or replacement but not with preoperative TV dysfunction or quadriscupid TV. The latter were risk factors for long term severe TV insufficiency or TV reoperation.