Common arterial trunk: current implementation of the primary and staged repair strategies.

OBJECTIVES: In this study, we report our experience on the primary and staged surgical approaches for common arterial trunk (CAT) repair. METHODS: Between August 2003 and February 2015, 16 consecutive patients underwent CAT repair in our institution. Two different approaches have been followed: group ‘primary repair’ (PR) consists of patients suitable for straightforward CAT repair, who underwent surgery electively at 1–3 months of age (n=13); group‘staged repair’ (SR) consists of critically ill neonates with CAT and poor preoperative status or coexisting interrupted aortic arch (n=3). They underwent staged CAT repair with aortic arch repair and right ventricular-topulmonary artery (RV-PA) shunt within the neonatal period, followed byan intracardiac repair later in infancy. RESULTS: Median age at initial surgical treatment was 8 days (range: 7–21 days) in group SR and 34 days (range: 14–91 days) in group PR (P=0.03). Mean Aristotle Comprehensive Complexity score was 11±0.6 (range: 11–13) in group PR and 18±3.1 (range: 15–21) in group SR (P<0.01). Follow-up was completed with a median duration of 3.6 years (range: 8 months to 11 years). There was neither early nor late mortality in both groups. In group SR, the median interval to second stage surgery was 216 days (range: 216–260 days). Seven patients (54%) in group PR required reoperation for RV-PA conduit failure (n= 4), truncal valve repair/replacement (n=2) orbo th (n=1). After initial surgery, Kaplan–Meier freedom from reoperation after 1, 2 and 8 years was 77±12, 68±13 and 20±17% in group PR, and 0% in group SR (log-rank P<0.01). Although all patients in group SR required reoperation to complete the anatomical correction (second stage procedure), there was no surgical reintervention of truncal valve and aortic arch thereafter. CONCLUSIONS: Routine elective CAT repair could be safely performed at 1–3 months of age. However, neonatal CAT repair could be associated with a higher mortality especially in the presence of an interrupted aortic arch. In such cases, a staged CAT repair seems to be associated with favourable postoperative course and improved hospital survival, despite the inevitable need for reoperation, which can be performed at a relatively low risk.