Truncal Valve Stenosis, Regurgitation in Truncus Arteriosus and Risk for Truncal Valve Intervention

This article is part of Cardiology Advisor‘s coverage of AHA Scientific Sessions 2020.

Patients who have truncus arteriosus (TA) with moderate or worse initial truncal valve regurgitation or stenosis may be at risk for truncal valve intervention, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2020, held virtually from November 13 to 17, 2020

In this retrospective cohort study, researchers analyzed the data of 148 patients who undergone initial TA repair at Boston Children’s Hospital (BCH) from 1985 to 2016 and survived ≥30 days postoperatively. Initial TA repair was defined as ventricular septal defect closure, detachment of the pulmonary arteries from the common trunk, and establishment of continuity between the right ventricle and pulmonary arteries. Any interventional catheterization or surgery after the initial repair was considered a reintervention.

In this cohort, 69 patients (46%) had TA type 1, 24 (16%) had TA type 4 with aortic arch coarctation or interruption, 45 patients (32%) had a quadricuspid valve, and 42 patients (28%) had coronary artery abnormalities, defined as stenosis or atresia, intramural course, and abnormal origins. Prior to full TA repair, 49.3% of patients had none or trivial regurgitation, 37.5% had mild regurgitation, 12.5% had moderate regurgitation, and 1 patient had severe regurgitation. Mild truncal valve stenosis was detected in 10 patients (7%).

After initial TA repair, 123 patients (83%) underwent ≥1 surgical or catheter-based interventions. Independent risk factors for truncal valve intervention identified in a multivariate analysis were: moderate or greater preoperative initial truncal valve regurgitation (hazard ratio [HR], 4.7; 95% CI, 2.26-10.07) or stenosis (HR, 4.12; 95% CI, 2.11-8.04); moderate or greater truncal valve regurgitation at initial hospital discharge after full repair (HR, 8.6; 95% CI, 3.95-18.69); and anomaly of a single coronary ostium (HR, 6.94; 95% CI, 1.5-21.19). Development of moderate or greater truncal valve regurgitation was found to be associated with larger truncal root z-scores before TA repair (odds ratio [OR], 2.1; 95% CI, 1.06-4.29; P =.03) and during follow-up (OR, 1.67; 95% CI, 1.24-2.24; P =.001) in a univariate analysis.

Limitations of this study include its retrospective design, and the fact that researchers attempted to limit the referral bias of more complex cases and the potential loss of long-term follow-up by excluding patients who did not reside in the BCH area at the time of surgery. “Patients with moderate or worse initial truncal valve regurgitation or stenosis, residual truncal valve regurgitation after initial TA repair, and single coronary ostium are potentially at higher risk for truncal valve intervention,” the researchers concluded. “Truncal root z-score may be useful to identify which patients are at risk [of] developing truncal valve dysfunction.”

Reference

Gellis L, Binney G, Alshawabkeh L, et al. Long-term outcomes of the truncal valve in truncus arteriosus. Presented at: AHA Scientific Sessions 2020; November 13-17, 2020. Presentation 535.

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