Coronary Artery Anomalies Are Associated with Increased Mortality After Truncus Arteriosus Repair.

Abstract Background Truncus arteriosus is associated with coronary anomalies. We identified coronary artery lesions in patients undergoing repair of truncus arteriosus, defined the impact of lesions on mortality, and studied the effect of surgical intervention of coronary lesions. Methods Retrospective review identified 107 patients with truncus repair (1995-2019). Coronary lesions were categorized as ostial stenosis, intramural, juxtacommissural origin, and single coronary. Survival analysis characterized survival after truncus repair and studied association of coronary lesions and mortality. Results Among 107 patients with truncus repair, 34 patients had at least one coronary lesion. Median follow-up time was 7 years, with 85% 5-year survival. Coronary lesions included: ostial stenosis, intramurality, and juxtacommissural origin were associated with increased mortality, while single coronaries did not impact survival. Eleven patients had 1 coronary lesion and 6 patients with 2 coronary lesions had similar (80% and 83%) 5-year survival. Eight patients with 3 coronary lesions had 24% 5-year survival (p=0.0003). Among patients with 1 or 2 lesions, surgical intervention on the coronaries tended to be associated with longer 5-year survival (100% vs 62%, p=0.06). All patients with 3 lesions underwent coronary artery intervention, with 24% 5-year survival. Conclusions Impact of coronary lesions on mortality after truncus repair increases with number of lesions. Coronary artery intervention may be associated with improved time-related survival among patients with 1 or 2 lesions. Patients with the most complex anomalies (3 lesions), have poor survival and warrant ongoing study of repair techniques.