Cuomo Michela, Moscarelli Marco, Pollari Francesco, Dewald Oliver, Oppido Guido, Barili Fabio, Parolari Alessandro, Purbojo Ariawan, Cesnjevar Robert Anton
Department of Cardiac Surgery, University of Erlangen, Erlangen, Germany.
Department of Cardiovascular Surgery, GVM Care and Research, Palermo, Italy.
JTCVS Open. 2025 Jun 20;26:182-195. doi: 10.1016/j.xjon.2025.05.012. eCollection 2025 Aug.
Primary repair of the common arterial trunk is still burdened by high mortality rates. Because of the low incidence and complexity of common arterial trunk, evidence is limited to reports with small sample sizes, and issues such as the ideal surgical timing to address the primary repair are still debated. We performed a systematic review and meta-analysis to estimate the pooled mortality, morbidity, and reoperation rates after common arterial trunk primary repair.
PubMed, Google Scholar, Ovid-MEDLINE, and Ovid-EMBASE databases were searched to identify studies on common arterial trunk primary repair. Eligible studies reporting early mortality (primary outcome) after common arterial trunk primary repair were screened. Secondary outcomes were survival and reoperation on the right ventricle pulmonary artery conduit at the follow-up.
Among 319 articles retrieved, 43 studies including 4844 patients met the inclusion criteria. Pooled early mortality was 11.23% (95% CI, 9.4-13.37). There was no difference in the early mortality rates between multicenter and single-center studies. The sub-analysis comparing the neonatal and non-neonatal repair groups showed a significantly lower mortality rate in the neonatal group ( < .001). At the follow-up, the pooled mortality was 0.72% per year (95% CI, 0.51-0.93) and the reoperation rate on the right ventricle pulmonary artery conduit was 3.4% per year (95% CI, 2.24-4.57).
The early mortality rate after common arterial trunk primary repair is relatively high, and the reoperation rate per year on the right ventricle pulmonary artery conduit is a major problem. This meta-analysis supports the current tendency of performing primary repair during the neonatal period and can serve as a benchmark for future studies.
共同动脉干的一期修复死亡率仍然很高。由于共同动脉干的发病率低且病情复杂，证据仅限于小样本量的报告，关于一期修复的理想手术时机等问题仍存在争议。我们进行了一项系统评价和荟萃分析，以估计共同动脉干一期修复后的合并死亡率、发病率和再次手术率。
检索PubMed、谷歌学术、Ovid-MEDLINE和Ovid-EMBASE数据库，以确定关于共同动脉干一期修复的研究。筛选符合条件的报告共同动脉干一期修复后早期死亡率（主要结局）的研究。次要结局是随访时的生存率和右心室肺动脉导管再次手术情况。
在检索到的319篇文章中，43项研究（包括4844例患者）符合纳入标准。合并早期死亡率为11.23%（95%CI，9.4-13.37）。多中心和单中心研究的早期死亡率没有差异。比较新生儿和非新生儿修复组的亚组分析显示，新生儿组的死亡率显著较低（<0.001）。随访时，每年的合并死亡率为0.72%（95%CI，0.51-0.93），右心室肺动脉导管每年的再次手术率为3.4%（95%CI，2.24-4.57）。
共同动脉干一期修复后的早期死亡率相对较高，右心室肺动脉导管每年的再次手术率是一个主要问题。这项荟萃分析支持目前在新生儿期进行一期修复的趋势，并可为未来的研究提供基准。
