Long-Term Outcomes of Truncus Arteriosus Repair: A Modulated Renewal Competing Risks Analysis

ABSTRACT Objective In this study, we sought to identify independent risk factors for mortality and reintervention after early surgical correction of truncus arteriosus (TA) using a novel statistical method. Methods Patients undergoing neonatal/infant TA repair between January 1984 and December 2018 were reviewed retrospectively. An innovative statistical strategy was applied integrating competing risks analysis with modulated renewal for time-to-event modeling. Results 204 patients were included in the study. Mortality occurred in 32 patients (15%). Smaller right ventricle to pulmonary artery (RV-PA) conduit size and truncal valve (TV) insufficiency at birth were significantly associated with overall mortality (RV-PA conduit size: Hazard ratio, HR: 1.34; 95% Confidence Interval, CI: 1.08-1.66, P=.008; TV insufficiency: HR: 2.5; 95% CI: 1.13-5.53, P=.024). TV insufficiency at birth, TV intervention at index repair, and number of cusps (4 vs 3) were associated with TV reoperations (TV insufficiency: HR: 2.38; 95%, CI: 1.13-5.01, P=.02; cusp number: HR: 6.62; 95% CI: 2.54-17.3, P Conclusions Smaller RV-PA conduit size and TV insufficiency at birth were associated with overall mortality after TA repair. Quadricuspid TV, the presence of TV insufficiency at the time of diagnosis and TV intervention at index repair were associated with an increased risk of reoperation. The size of the RV-PA conduit at index surgery is the single most important factor for early reoperation and catheter-based reintervention on the conduit.