Impact of Truncal Valve Repair on Survival, Reintervention, and Left Ventricular Function.

Background: Truncal valve insufficiency (TVI) is one of the risk factors for death in neonatal primary repair for common arterial trunk (CAT).

Methods: In this single-center retrospective case-matched controlled study, 16 consecutive CAT patients from 2000 to 2018 with moderate to severe truncal valve regurgitation (TVR2-3), undergoing primary CAT surgery with truncal valve repair, were matched to 16 CAT patients with none or mild truncal valve regurgitation (TVR1-0).

Results: The TVR2-3 group had 11 (69%) patients with moderate and 5 (31%) patients with severe TVI, with an operative median age of 7 (4-19) days. Survival at median follow-up of 17 years after repair was 70% and 80% in the TVR2-3 and TVR0-1 groups, respectively ( > .99), with 2 early deaths in the TVR2-3 group occurring after reintervention for residual TVI. Rate of surgical truncal valve reintervention at 5 years postoperatively was 67% for TVR2-3 ( = .005). TVR2-3 experienced greater residual TVI at discharge and 1 year after repair, with severity of truncal valve dysfunction converging between groups as more patients in TVR0-1 developed mild to moderate TVI over time and TVR2-3 patients underwent reintervention for clinically significant TVI. Significant left ventricular (LV) dilation was observed in the TVR2-3 group after 3 years from repair ( = .001), but LV ejection fraction was comparable between groups.

Conclusions: Truncal valve reintervention burden (ie, repair or replacement) is greater in the TVR2-3 population, with higher truncal valve-related early death. Progressive LV enlargement in the TVR2-3 group due to residual TVI was well tolerated. Ventricular remodeling did not have a notable impact on LV ejection fraction or clinical status.