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