A modified approach in the repair of type I and II truncus arteriosus to promote branch pulmonary arterial growth and limit early reoperationCentral MessagePerspective
Objective: Maintaining adequate branch pulmonary arterial growth is critical in preventing early (<3 years) right ventricular outflow tract reoperation after the repair of truncus arteriosus. We hypothesized that a modified truncus arteriosus repair keeping the branch pulmonary arteries in situ w...
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Elsevier
2022-12-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250722005144 |
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| author | Michael F. Swartz, PhD Shuichi Yoshitake, MD Jill M. Cholette, MD Nader Atallah-Yunes, MD Hongyue Wang, PhD George M. Alfieris, MD |
| author_facet | Michael F. Swartz, PhD Shuichi Yoshitake, MD Jill M. Cholette, MD Nader Atallah-Yunes, MD Hongyue Wang, PhD George M. Alfieris, MD |
| author_sort | Michael F. Swartz, PhD |
| collection | DOAJ |
| description | Objective: Maintaining adequate branch pulmonary arterial growth is critical in preventing early (<3 years) right ventricular outflow tract reoperation after the repair of truncus arteriosus. We hypothesized that a modified truncus arteriosus repair keeping the branch pulmonary arteries in situ would promote branch pulmonary arterial growth and limit early right ventricular outflow tract reoperation. Methods: For infants requiring repair for type I and II truncus arteriosus, the truncal root was septated through a hockey stick incision keeping the branch pulmonary arteries in situ, the ventricular septal defect was closed, and a short aortic homograft was used to reconstruct the right ventricular outflow tract. Echocardiograms measured preoperative and follow-up branch pulmonary artery diameter. Results: Between 1998 and 2020, 41 infants were repaired using the modified approach (type I, 28; type II, 13). With a median follow-up of 11.6 (interquartile range, 3.1-15.5) years, there was no significant change between preoperative left pulmonary artery and right pulmonary artery Z-scores and their corresponding follow-up measurement (left pulmonary artery: 0.97, interquartile range, 0.6-1.6 vs left pulmonary artery: 1.4, interquartile range, –0.3 to 1.9) (right pulmonary artery: 0.6, interquartile range, –0.4 to 1.7 vs right pulmonary artery: 0.3 interquartile range, 0.5-0.9). Only 7.3% (n = 2) of follow-up right pulmonary artery Z-scores were less than 2.5 Z-scores below preoperative measurements. Four children (9.8%) required early right ventricular outflow tract reoperation. On multivariable analysis, larger conduit Z-scores were associated with greater time to right ventricular outflow tract reoperation (hazard ratio, 0.55, confidence interval, 0.307-0.984; P = .043). Conclusions: Maintaining the branch pulmonary arteries in situ at initial truncus arteriosus repair allows for branch pulmonary arterial growth, limiting early right ventricular outflow tract reoperation. |
| format | Article |
| id | doaj-art-adfdb8fc8b2d414cac485760f322442c |
| institution | DOAJ |
| issn | 2666-2507 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
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| series | JTCVS Techniques |
| spelling | doaj-art-adfdb8fc8b2d414cac485760f322442c2025-08-20T03:04:47ZengElsevierJTCVS Techniques2666-25072022-12-011619621110.1016/j.xjtc.2022.09.012A modified approach in the repair of type I and II truncus arteriosus to promote branch pulmonary arterial growth and limit early reoperationCentral MessagePerspectiveMichael F. Swartz, PhD0Shuichi Yoshitake, MD1Jill M. Cholette, MD2Nader Atallah-Yunes, MD3Hongyue Wang, PhD4George M. Alfieris, MD5Department of Surgery, University of Rochester Medical Center, Rochester, NY; Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY; Address for reprints: Michael F. Swartz, PhD, Strong Memorial Hospital, Box Surg/Cardiac, 601 Elmwood Ave, Rochester, NY 14642.Department of Surgery, University of Rochester Medical Center, Rochester, NY; Pediatric Cardiac Consortium of Upstate New York, Syracuse, NYPediatric Cardiac Consortium of Upstate New York, Syracuse, NY; Department of Pediatrics, University of Rochester Medical Center, Rochester, NYPediatric Cardiac Consortium of Upstate New York, Syracuse, NY; Department of Pediatrics, University of Rochester Medical Center, Rochester, NYDepartment of Biostatistics, University of Rochester Medical Center, Rochester, NYDepartment of Surgery, University of Rochester Medical Center, Rochester, NY; Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY; Department of Pediatrics, University of Rochester Medical Center, Rochester, NYObjective: Maintaining adequate branch pulmonary arterial growth is critical in preventing early (<3 years) right ventricular outflow tract reoperation after the repair of truncus arteriosus. We hypothesized that a modified truncus arteriosus repair keeping the branch pulmonary arteries in situ would promote branch pulmonary arterial growth and limit early right ventricular outflow tract reoperation. Methods: For infants requiring repair for type I and II truncus arteriosus, the truncal root was septated through a hockey stick incision keeping the branch pulmonary arteries in situ, the ventricular septal defect was closed, and a short aortic homograft was used to reconstruct the right ventricular outflow tract. Echocardiograms measured preoperative and follow-up branch pulmonary artery diameter. Results: Between 1998 and 2020, 41 infants were repaired using the modified approach (type I, 28; type II, 13). With a median follow-up of 11.6 (interquartile range, 3.1-15.5) years, there was no significant change between preoperative left pulmonary artery and right pulmonary artery Z-scores and their corresponding follow-up measurement (left pulmonary artery: 0.97, interquartile range, 0.6-1.6 vs left pulmonary artery: 1.4, interquartile range, –0.3 to 1.9) (right pulmonary artery: 0.6, interquartile range, –0.4 to 1.7 vs right pulmonary artery: 0.3 interquartile range, 0.5-0.9). Only 7.3% (n = 2) of follow-up right pulmonary artery Z-scores were less than 2.5 Z-scores below preoperative measurements. Four children (9.8%) required early right ventricular outflow tract reoperation. On multivariable analysis, larger conduit Z-scores were associated with greater time to right ventricular outflow tract reoperation (hazard ratio, 0.55, confidence interval, 0.307-0.984; P = .043). Conclusions: Maintaining the branch pulmonary arteries in situ at initial truncus arteriosus repair allows for branch pulmonary arterial growth, limiting early right ventricular outflow tract reoperation.http://www.sciencedirect.com/science/article/pii/S2666250722005144branch pulmonary artery stenosisreoperationtruncus arteriosus |
| spellingShingle | Michael F. Swartz, PhD Shuichi Yoshitake, MD Jill M. Cholette, MD Nader Atallah-Yunes, MD Hongyue Wang, PhD George M. Alfieris, MD A modified approach in the repair of type I and II truncus arteriosus to promote branch pulmonary arterial growth and limit early reoperationCentral MessagePerspective JTCVS Techniques branch pulmonary artery stenosis reoperation truncus arteriosus |
| title | A modified approach in the repair of type I and II truncus arteriosus to promote branch pulmonary arterial growth and limit early reoperationCentral MessagePerspective |
| title_full | A modified approach in the repair of type I and II truncus arteriosus to promote branch pulmonary arterial growth and limit early reoperationCentral MessagePerspective |
| title_fullStr | A modified approach in the repair of type I and II truncus arteriosus to promote branch pulmonary arterial growth and limit early reoperationCentral MessagePerspective |
| title_full_unstemmed | A modified approach in the repair of type I and II truncus arteriosus to promote branch pulmonary arterial growth and limit early reoperationCentral MessagePerspective |
| title_short | A modified approach in the repair of type I and II truncus arteriosus to promote branch pulmonary arterial growth and limit early reoperationCentral MessagePerspective |
| title_sort | modified approach in the repair of type i and ii truncus arteriosus to promote branch pulmonary arterial growth and limit early reoperationcentral messageperspective |
| topic | branch pulmonary artery stenosis reoperation truncus arteriosus |
| url | http://www.sciencedirect.com/science/article/pii/S2666250722005144 |
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