Timing the Repair in Truncus Arteriosus: A Systematic Review and Meta-analysis with Reconstructed Time-to-Event Data Comparing Staged Repair and Primary Correction.

In 30 seconds

This systematic review and meta-analysis compared staged repair (SR) with primary correction (PC) for truncus arteriosus in pediatric patients. Five studies included 534 patients. SR was associated with fewer unplanned surgical reinterventions after complete repair (OR 0.28; 95% CI 0.14-0.55; P = .02) and greater freedom from reoperation over 12 years (HR 0.39; 95% CI 0.17-0.89; P = .025). Follow-up mortality and reported early perioperative outcomes did not differ significantly. The authors describe the evidence as low certainty and advise cautious interpretation.

Key findings

• Unplanned surgical reinterventions after complete repair were less frequent with SR (OR 0.28; 95% CI 0.14-0.55; P = .02).
• Reconstructed time-to-event data showed greater freedom from reoperation with SR over 12 years (HR 0.39; 95% CI 0.17-0.89; P = .025).
• Follow-up mortality did not differ significantly between SR and PC (OR 0.59; 95% CI 0.10-3.34; P = .32).
• Early perioperative outcomes, including bypass and cross-clamp times, early mortality, and hospital stay, were similar between approaches.

Why it matters

The choice between staged and primary repair is debated in truncus arteriosus. These pooled findings suggest that staged repair may be associated with fewer later reoperations without a detected difference in survival or early perioperative outcomes. The results help frame the trade-offs clinicians and families may consider, while the limited, low-certainty evidence means they do not establish superiority.

What to keep in mind

The analysis included only five studies, and the authors characterize the evidence as low certainty and based on limited retrospective studies. Reoperation time-to-event data were reconstructed from published Kaplan-Meier curves.