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Multicenter Analysis of Truncal Valve Management and Outcomes in Children with Truncus Arteriosus

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Abstract

Truncal valve management in patients with truncus arteriosus is a clinical challenge, and indications for truncal valve intervention have not been defined. We sought to evaluate truncal valve dysfunction and primary valve intervention in patients with truncus arteriosus and determine risk factors for later truncal valve intervention. We conducted a retrospective cohort study of children who underwent truncus arteriosus repair at 15 centers between 2009 and 2016. Multivariable competing risk analysis was performed to determine risk factors for later truncal valve intervention. We reviewed 252 patients. Forty-two patients (17%) underwent truncal valve intervention during their initial surgery. Postoperative extracorporeal support, CPR, and operative mortality for patients who underwent truncal valve interventions were statistically similar to the rest of the cohort. Truncal valve interventions were performed in 5 of 64 patients with mild insufficiency; 5 of 16 patients with mild-to-moderate insufficiency; 17 of 35 patients with moderate insufficiency; 5 of 9 patients with moderate-to-severe insufficiency; and all 10 patients with severe insufficiency. Twenty patients (8%) underwent later truncal valve intervention, five of whom had no truncal valve intervention during initial surgical repair. Multivariable analysis revealed truncal valve intervention during initial repair (HR 11.5; 95% CI 2.5, 53.2) and moderate or greater truncal insufficiency prior to initial repair (HR 4.0; 95% CI 1.1, 14.5) to be independently associated with later truncal valve intervention. In conclusion, in a multicenter cohort of children with truncus arteriosus, 17% had truncal valve intervention during initial surgical repair. For patients in whom variable truncal valve insufficiency is present and primary intervention was not performed, late interventions were uncommon. Conservative surgical approach to truncal valve management may be justifiable.

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Data Availability

Data have not been submitted to a public data repository.

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Funding

This work was supported by funding from the Department of Pediatrics at Indiana University School of Medicine through a Riley Children’s Foundation Grant.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Section Head, Pediatric Cardiac Critical Care, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Cohen Children’s Medical Center of NY, New Hyde Park, NY, USA

    Adnan M. Bakar

  2. Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    John M. Costello

  3. Department of Cardiac Surgery, University of Michigan, C.S. Mott Children’s Hospital, Ann Arbor, MI, USA

    Peter Sassalos

  4. Department of Pediatrics, University of Utah School of Medicine, Primary Children’s Hospital, Salt Lake City, UT, USA

    Venu Amula

  5. Department of Pediatrics, Medical University of South Carolina Children’s Hospital, Charleston, SC, USA

    John M. Costello & Jason R. Buckley

  6. Department of Pediatrics, Columbia University College of Physicians & Surgeons, Morgan Stanley Children’s Hospital of New York, New York, NY, USA

    Arthur J. Smerling

  7. Department of Pediatrics, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Ilias Iliopoulos

  8. Department of Pediatrics, Children’s National Health System, Washington, DC, USA

    Christine M. Riley

  9. Department of Cardiac Surgery, Seattle Children’s Hospital, Seattle, WA, USA

    Aimee Jennings

  10. Department of Pediatrics, Wayne State University School of Medicine, Children’s Hospital of Michigan, Detroit, MI, USA

    Katherine Cashen

  11. Department of Pediatrics, University of Central Florida College of Medicine, The Heart Center at Arnold Palmer Hospital for Children, Orlando, FL, USA

    Sukumar Suguna Narasimhulu

  12. Department of Pediatrics, Cleveland Clinic, Cleveland, OH, USA

    Keshava Murthy Narayana Gowda

  13. Department of Pediatrics, University of Wisconsin, Madison, WI, USA

    Michael Wilhelm

  14. Department of Pediatrics, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA

    Aditya Badheka

  15. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA

    James E. Slaven

  16. Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children At Indiana University Health, Indianapolis, IN, USA

    Christopher W. Mastropietro

Authors
  1. Adnan M. Bakar
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  2. John M. Costello
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  3. Peter Sassalos
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  4. Venu Amula
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  5. Jason R. Buckley
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  7. Ilias Iliopoulos
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  8. Christine M. Riley
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  9. Aimee Jennings
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  10. Katherine Cashen
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  11. Sukumar Suguna Narasimhulu
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  12. Keshava Murthy Narayana Gowda
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  13. Michael Wilhelm
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  14. Aditya Badheka
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  15. James E. Slaven
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  16. Christopher W. Mastropietro
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Consortia

the Collaborative Research from the Pediatric Cardiac Intensive Care Society (CoRe-PCICS) Investigators

Contributions

All authors contributed to study conception and design, material preparation, and data collection. Analysis was performed by CM and JS. The first draft was written by AB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Adnan M. Bakar.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This retrospective chart review study was approved by the institutional review boards at all centers and was performed in accordance to the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed Consent

Due to the retrospective collection of data, the need for informed consent was waived by the IRBs of all participating centers.Due to the retrospective collection of data, the need for informed consent was waived by the IRBs of all participating centers.

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Bakar, A.M., Costello, J.M., Sassalos, P. et al. Multicenter Analysis of Truncal Valve Management and Outcomes in Children with Truncus Arteriosus. Pediatr Cardiol 41, 1473–1483 (2020). https://doi.org/10.1007/s00246-020-02405-z

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  • DOI: https://doi.org/10.1007/s00246-020-02405-z

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