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Outcomes in Primary Repair of Truncus Arteriosus with Significant Truncal Valve Insufficiency: A Systematic Review and Meta-analysis

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Abstract

Data regarding the effect of significant TVI on outcomes after truncus arteriosus (TA) repair are limited. The aim of this meta-analysis was to summarize outcomes among patients aged ≤ 24 months undergoing TA repair with at least moderate TVI. A systematic literature search was conducted in PubMed, Scopus, and CINAHL Complete from database inception through June 1, 2022. Studies reporting outcomes of TA repair in patients with moderate or greater TVI were included. Studies reporting outcomes only for patients aged > 24 months were excluded. The primary outcome was overall mortality, and secondary outcomes included early mortality and truncal valve reoperation. Random-effects models were used to estimate pooled effects. Assessment for bias was performed using funnel plots and Egger’s tests. Twenty-two single-center observational studies were included for analysis, representing 1,172 patients. Of these, 232 (19.8%) had moderate or greater TVI. Meta-analysis demonstrated a pooled overall mortality of 28.0% after TA repair among patients with significant TVI with a relative risk of 1.70 (95% CI [1.27–2.28], p < 0.001) compared to patients without TVI. Significant TVI was also significantly associated with an increased risk for early mortality (RR 2.04; 95% CI [1.36–3.06], p < 0.001) and truncal valve reoperation (RR 3.90; 95% CI [1.40–10.90], p = 0.010). Moderate or greater TVI before TA repair is associated with an increased risk for mortality and truncal valve reoperation. Management of TVI in patients remains a challenging clinical problem. Further investigation is needed to assess the risk of concomitant truncal valve surgery with TA repair in this population.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Medical University of South Carolina, 114 Doughty Street, Charleston, SC, 29425, USA

    Alekhya Mitta, Andrew D. Vogel, Scott M. Bradley, Minoo N. Kavarana, T. Konrad Rajab & Jennie H. Kwon

  2. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA

    Jeffrey E. Korte

  3. Department of Research & Education Services, Medical University of South Carolina, Charleston, SC, USA

    Emily Brennan

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  1. Alekhya Mitta
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  2. Andrew D. Vogel
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by EB, AM, JK, and JK. The first draft of the manuscript was written by AM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jennie H. Kwon.

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Mitta, A., Vogel, A.D., Korte, J.E. et al. Outcomes in Primary Repair of Truncus Arteriosus with Significant Truncal Valve Insufficiency: A Systematic Review and Meta-analysis. Pediatr Cardiol 44, 1649–1657 (2023). https://doi.org/10.1007/s00246-023-03231-9

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