초록접수 현황
| 16F-128 | 구연 발표 |
Impact of Truncal Valve Insufficiency on the Late Outcomes after Surgical Interventions for Persistent Truncus Arteriosus
Won Kyoun Park, Jong Yoon Park, Chun Soo Park, Jeong-Jun Park, Tae-Jin Yun
Department of Pediatric Cardiac Surgery, Asan Medical Center, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
Background : We sought to determine whether truncal valve Insufficiency (TVI) at initial presentation is a significant risk factor for adverse outcomes after various surgical interventions for persistent truncus arteriosus (PTA).
Methods : Retrospective review of 32 patients with PTA (20 males) who underwent surgical interventions between 1989 and 2016 was conducted. TVI was present at initial presentation in 21 (I in 17, II in 2, III in 2). Truncal valve stenosis (TVS) (trans-valvar velocity 2.5 m/s) was initially associated in 16 (13 with TVI). Initial surgical interventions (median age: 14 days) were palliative procedures in 12 (truncus separation and right ventricle to pulmonary artery conduit placement in 8, bilateral pulmonary artery banding, b-PAB, in 4) and primary Rastelli-type repair (RTR) in 20
Results : Early mortality after initial operations occurred in 7 patients (7/32, 21.9%), either after RTR (n=6) or b-PAB (n=1). Median flow velocity across the truncal valve regressed in all patients with initial TVS after initial operations (3.3 m/sec to 2.0 m/sec, P=0.012). Six patients underwent surgical interventions for TVI (repair in 2, mechanical valve replacement in 4) or upon RTR (n=3) or after RTR (n=3). Overall survival and freedom from death or surgical intervention for TVI at 5 years were 62.2 % and 46.2%, respectively. On Cox proportional Hazards model, TVI at initial presentation (HR: 4.5, 95% CI: 1.3-15.7 P=0.018) was associated with deceased time to adverse composite outcomes
Conclusion : While TVS may regress either by repair or palliation, TVI at initial presentation leads to adverse outcome.
Methods : Retrospective review of 32 patients with PTA (20 males) who underwent surgical interventions between 1989 and 2016 was conducted. TVI was present at initial presentation in 21 (I in 17, II in 2, III in 2). Truncal valve stenosis (TVS) (trans-valvar velocity 2.5 m/s) was initially associated in 16 (13 with TVI). Initial surgical interventions (median age: 14 days) were palliative procedures in 12 (truncus separation and right ventricle to pulmonary artery conduit placement in 8, bilateral pulmonary artery banding, b-PAB, in 4) and primary Rastelli-type repair (RTR) in 20
Results : Early mortality after initial operations occurred in 7 patients (7/32, 21.9%), either after RTR (n=6) or b-PAB (n=1). Median flow velocity across the truncal valve regressed in all patients with initial TVS after initial operations (3.3 m/sec to 2.0 m/sec, P=0.012). Six patients underwent surgical interventions for TVI (repair in 2, mechanical valve replacement in 4) or upon RTR (n=3) or after RTR (n=3). Overall survival and freedom from death or surgical intervention for TVI at 5 years were 62.2 % and 46.2%, respectively. On Cox proportional Hazards model, TVI at initial presentation (HR: 4.5, 95% CI: 1.3-15.7 P=0.018) was associated with deceased time to adverse composite outcomes
Conclusion : While TVS may regress either by repair or palliation, TVI at initial presentation leads to adverse outcome.
책임저자: Tae-Jin Yun
Department of Pediatric Cardiac Surgery, Asan Medical Center, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
발표자: Won Kyoun Park, E-mail : medkyoun@naver.com