Original article: cardiovascular
Surgical management of severe truncal insufficiency: experience with truncal valve remodeling techniques

Presented at the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.
https://doi.org/10.1016/S0003-4975(01)02785-0Get rights and content

Abstract

Background. Truncal valve insufficiency has been a significant short- and long-term risk factor for repair of truncus arteriosus. Recent reports have documented the virtues of truncal valve repair. The purpose of this report is to review our experience with truncal valve repair and illustrate our techniques.

Methods. Between 1995 and 2000, 8 patients had interventions for severe truncal valve insufficiency at primary repair (3 patients) or in conjunction with conduit replacement (5 patients). One neonate had truncal valve replacement at initial repair early in the experience. The other 7 patients had truncal valve repair, 3 by valvar suture techniques. The remaining 4 patients had leaflet excision and annular remodeling in 3 (coronary reimplantation was required in 2) and commissure resuspension in 1 patient.

Results. Trivial to mild truncal valve insufficiency is present in the patients who had leaflet excision and annular remodeling (n = 3) and commissure resuspension (n = 1). Of the 3 patients who had valvar suture truncal valve repair, there was one death and 2 patients required acute valve replacement. The 7 survivors are doing well 1 month to 6 years postoperatively.

Conclusions. Truncal valve repair by valvar suture techniques has not been successful in our practice. Truncal valve remodeling by leaflet excision and reduction annuloplasty is an effective method for truncal valve repair. When leaflet excision of a coronary sinus of Valsalva is required, coronary artery translocation can be accomplished.

Section snippets

Material and methods

Between 1995 and 2000, 8 patients underwent truncal valve repair (n = 5) or replacement (n = 3) in association with primary repair or right ventricular-to-pulmonary artery conduit replacement for truncus arteriosus. Supportive operative techniques were standard and included aortobicaval cardiopulmonary bypass with systemic cooling to 28°C, left ventricular venting (through the right superior pulmonary vein), and combinations of antegrade–retrograde cold blood cardioplegia. The various

Results

There was one early death (12.5%) and no late deaths. The operative death occurred in a 5-day-old infant with severe hemodynamic instability. Problems with ineffective myocardial preservation and unsatisfactory valve repair resulted in postoperative myocardial dysfunction and eventual death despite extracorporeal membrane oxygenation. Significant complications occurred in 2 patients (Table 1): one required postoperative extracorporeal membrane oxygenation; the other had significant

Comment

The introduction and development of truncal valve repair for severe insufficiency in patients with truncus arteriosus has significantly improved short-term and midterm outcomes 13, 14, 15, 16, 17, 18. Unlike many other arterial trunk and aortic valve lesions, the truncal valve has favorable anatomy for reparative reduction techniques owing to its large size, compliant annulus, and in many cases, multiple leaflets. The concept of the reduction leaflet and annuloplasty technique takes its roots

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