Congenital: Truncal Valve
The quadricuspid truncal valve: Surgical management and outcomes

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Abstract

Objective

To determine the outcomes of patients with a quadricuspid truncal valve (TV) and durability of TV repair.

Method

We reviewed 56 patients with truncus arteriosus and a quadricuspid TV who underwent complete repair between 1979 and 2018.

Results

TV insufficiency was present in 39 patients (mild, n = 22; moderate, n = 14; and severe, n = 3). Fourteen patients had concomitant TV surgery. Early mortality in patients who had concomitant TV surgery was 14% (2 out of 14 patients) and overall survival was 77.1% ± 11.7% at 15 years. Freedom from TV reoperation was 30.3% ± 14.6% at 15 years. Early mortality in patients who did not undergo concomitant TV surgery was 9.5% (4 out of 42 patients) and overall survival was 74.9% ± 6.9% at 15 years. Progression of TV insufficiency requiring TV surgery occurred in 16.7% (7 out of 42 patients). Freedom from TV reoperation was 77.1% ± 7.8% at 15 years. The most common method of repair was tricuspidization of the TV. Freedom from TV reoperation was 64.3% ± 21.0% at 10 years after tricuspidization and 0% at 6 years after other types of TV surgery. Overall follow-up was 97.6% (41 out of 42 patients) complete for survivors with median follow-up of 16.6 years. At last follow-up there was no TV insufficiency in 16 patients, mild insufficiency in 24 patients, and moderate insufficiency in 1 patient.

Conclusions

More than one-third of patients with a quadricuspid TV require TV surgery. Tricuspidization of the quadricuspid TV appears to be a durable repair option with good long-term outcomes.

Key Words

truncal valve
truncus arteriosus
surgery

Abbreviations and Acronyms

TTE
transthoracic echocardiogram
TV
truncal valve

Cited by (0)

Dr Naimo is supported by a National Health and Medical Research Council Medical Research Postgraduate Scholarship and an Australian Government Research Training Program Scholarship (No. 1150242). Dr Fricke is supported by a National Health and Medical Research Council Postgraduate Scholarship and an Australian Government Research Training Program Scholarship (No. 1134203). Dr Lee is supported by a National Health and Medical Research Council Medical Research Postgraduate Scholarship and an Australian Government Research Training Program (No. 1134274). Dr d'Udekem is a practitioner fellow of the National Health and Medical Research Council of Australia (No. 1082186).