OBJECTIVES Primary repair of common arterial trunk (CAT) is burdened by high mortality rates, especially in the presence of multiple risk factors. Timing, possible palliative methods, optimal management of associated cardiac lesions and handling of a poor preoperative state are still under discussion. METHODS We retrospectively analysed all patients who underwent surgery for CAT in our institution between 2008 and November 2020. We included 22 patients, 11 of whom received primary correction (PC) and 11 of whom underwent initial palliation by partial repair, leaving the ventricular septal defect open and connecting the right ventricle to the pulmonary arteries with a small valveless right ventricle-to-pulmonary artery conduit. A delayed correction (DC) was performed after 11.5 ± 3.6 months. RESULTS The overall operative mortality was 4.5%; 1 patient (affected by severe truncal valve stenosis and presenting in a poor state preoperatively) in the DC group died after palliation. The incidence of postoperative pulmonary hypertensive crisis was significantly higher in the PC group (P = 0.027). No patient from either group required postoperative extracorporeal support. Survival rates after 6 years differed slightly (PC group, 90%; DC group, 70%; log-rank = 0.270). CONCLUSIONS PC of CAT remains an optimal surgical approach for patients with an expected low mortality. However, our data support palliation and DC as a suitable alternative strategy, especially in the presence of significant risk factors like interrupted aortic arch, poor preoperative condition or complex surgical anatomy.

中文翻译：

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修复总动脉干：姑息治疗和延迟矫正作为选定患者的可行替代策略


目的 总动脉干 (CAT) 的初次修复面临着高死亡率的负担，特别是在存在多种危险因素的情况下。时机、可能的姑息方法、相关心脏病变的最佳治疗以及术前状态不佳的处理仍在讨论中。方法 我们回顾性分析了 2008 年至 2020 年 11 月期间在我们机构接受 CAT 手术的所有患者。我们纳入了 22 名患者，其中 11 名患者接受了初次矫正（PC），其中 11 名患者接受了部分修复的初步姑息治疗，留下了室间隔缺损。使用小型无瓣膜右心室至肺动脉导管打开并连接右心室至肺动脉。 11.5 ± 3.6 个月后进行延迟矫正 (DC)。结果 总手术死亡率为4.5%； DC组1例患者（因严重主干瓣膜狭窄且术前状态不佳）在姑息治疗后死亡。 PC组术后肺动脉高压危象的发生率显着较高（P = 0.027）。两组患者均无需术后体外支持。 6 年后的存活率略有不同（PC 组，90%；DC 组，70%；对数秩 = 0.270）。结论 对于预期死亡率较低的患者来说，PC 或 CAT 仍然是最佳手术方法。然而，我们的数据支持姑息治疗和 DC 作为一种合适的替代策略，特别是在存在主动脉弓中断、术前状况不佳或复杂的手术解剖等重大风险因素的情况下。