Contemporary Outcomes and Factors Associated With Mortality After a Fetal or Postnatal Diagnosis of Common Arterial Trunk

Conall T. Morgan, Angela Tang, Chun Po Fan, Fraser Golding, Cedric Manlhiot, Glen van Arsdell, Osami Honjo, Edgar Jaeggi

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Common arterial trunk (CAT) is a rare anomaly with a spectrum of pathology. We sought to identify current trends and factors associated with postnatal outcomes. METHODS: This was a single-centre review including 153 live births with planned surgery. Patients were analyzed as 2 cohorts based on era of CAT diagnosis (1990 to 1999 vs 2000 to 2014) and complexity of disease (simple vs complex). "Complex" required the association with significant aortic arch obstruction, truncal valve (TV) stenosis/regurgitation, and/or branch pulmonary artery (PA) hypoplasia, respectively. RESULTS: Sixteen (10%) died preoperatively, and this outcome was associated with significant TV stenosis (odds ratio [OR] 4.55; P = 0.01) and regurgitation (OR 3.17; P = 0.04); 130 (95%) of 137 operated infants underwent primary complete repair. Their survival rates to 1 year improved from 54% to 85% after 2000, although this outcome remained substantially lower for cases with a complex vs simple CAT repair (76% vs 95%; OR 6.46; P = 0.006). Other risk factors associated with decreased 1-year survival included diagnosis before 2000 (OR 4.48; P = 0.038) and a lower birth weight (OR 8.0 per kg weight; P = 0.001). Finally, of 93 survivors beyond year 1 of life, 76 (82%) had undergone a total of 224 reinterventions. Only 15 (16%) were alive without any surgical or catheter-based reintervention at study end. CONCLUSIONS: Despite recent surgical improvements, postnatal mortality continues to be substantial if CAT is complicated by significant pathology of the TV, aortic arch, or branch PAs. Reoperations and catheter interventions are eventualities for most patients during childhood.

Original languageEnglish (US)
Pages (from-to)446-452
Number of pages7
JournalThe Canadian journal of cardiology
Volume35
Issue number4
DOIs
StatePublished - Apr 1 2019
Externally publishedYes

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Odds Ratio
Mortality
Thoracic Aorta
Pathologic Constriction
Catheters
Pathology
Live Birth
Reoperation
Birth Weight
Pulmonary Artery
Survivors
Survival Rate
Weights and Measures
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Contemporary Outcomes and Factors Associated With Mortality After a Fetal or Postnatal Diagnosis of Common Arterial Trunk. / Morgan, Conall T.; Tang, Angela; Fan, Chun Po; Golding, Fraser; Manlhiot, Cedric; van Arsdell, Glen; Honjo, Osami; Jaeggi, Edgar.

In: The Canadian journal of cardiology, Vol. 35, No. 4, 01.04.2019, p. 446-452.

Research output: Contribution to journalArticle

Morgan, Conall T. ; Tang, Angela ; Fan, Chun Po ; Golding, Fraser ; Manlhiot, Cedric ; van Arsdell, Glen ; Honjo, Osami ; Jaeggi, Edgar. / Contemporary Outcomes and Factors Associated With Mortality After a Fetal or Postnatal Diagnosis of Common Arterial Trunk. In: The Canadian journal of cardiology. 2019 ; Vol. 35, No. 4. pp. 446-452.
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AU - Tang, Angela

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AU - Manlhiot, Cedric

AU - van Arsdell, Glen

AU - Honjo, Osami

AU - Jaeggi, Edgar

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AB - BACKGROUND: Common arterial trunk (CAT) is a rare anomaly with a spectrum of pathology. We sought to identify current trends and factors associated with postnatal outcomes. METHODS: This was a single-centre review including 153 live births with planned surgery. Patients were analyzed as 2 cohorts based on era of CAT diagnosis (1990 to 1999 vs 2000 to 2014) and complexity of disease (simple vs complex). "Complex" required the association with significant aortic arch obstruction, truncal valve (TV) stenosis/regurgitation, and/or branch pulmonary artery (PA) hypoplasia, respectively. RESULTS: Sixteen (10%) died preoperatively, and this outcome was associated with significant TV stenosis (odds ratio [OR] 4.55; P = 0.01) and regurgitation (OR 3.17; P = 0.04); 130 (95%) of 137 operated infants underwent primary complete repair. Their survival rates to 1 year improved from 54% to 85% after 2000, although this outcome remained substantially lower for cases with a complex vs simple CAT repair (76% vs 95%; OR 6.46; P = 0.006). Other risk factors associated with decreased 1-year survival included diagnosis before 2000 (OR 4.48; P = 0.038) and a lower birth weight (OR 8.0 per kg weight; P = 0.001). Finally, of 93 survivors beyond year 1 of life, 76 (82%) had undergone a total of 224 reinterventions. Only 15 (16%) were alive without any surgical or catheter-based reintervention at study end. CONCLUSIONS: Despite recent surgical improvements, postnatal mortality continues to be substantial if CAT is complicated by significant pathology of the TV, aortic arch, or branch PAs. Reoperations and catheter interventions are eventualities for most patients during childhood.

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