Key result
Conotruncal diagnosis is linked to ~2.1-fold higher hospital mortality after aortic root replacement in ACHD.
Why the study?
Hospital survival and risk factors after aortic root replacement in adult patients with repaired congenital conotruncal defects were not well characterized and needed comparison with other diagnoses.
Does an underlying conotruncal defect increase the risk of hospital mortality in adult patients undergoing aortic root replacement compared to other underlying diagnoses?
Cohort (n=2,544)
Yes
Does an underlying conotruncal defect increase the risk of hospital mortality in adult patients undergoing aortic root replacement compared to other underlying diagnoses?
Odds Ratio: 2.1
Absolute Event Rate: 6% vs 1.5%
p-value: p=0.037
Among adult patients undergoing aortic root replacement in congenital cardiac units, those with repaired conotruncal defects represent a distinct high-risk subgroup with approximately double the risk of hospital mortality.
Conotruncal defects signal higher hospital mortality risk after aortic root replacement in adults; leaves open whether specialized protocols improve outcomes in prospective cohorts.
OBJECTIVES: The study objectives were to characterize hospital survival and risk factors after aortic root replacement performed in adult patients by congenital units and to compare risk profiles of repaired conotruncal defects with other underlying diagnoses. METHODS: After aortic root replacement in a congenital cardiac unit, adult patients were identified in the European Congenital Heart Surgeons Association database. Underlying pathology, prior surgeries, and types of index aortic root surgery were characterized. Primary end points were hospital and 30-day survival. Secondary end points included circulatory arrest, length of intensive care unit and hospital stays, and discharge to chronic care facility. Multiple logistic regression analyses were performed to test for independent risk factors. RESULTS: A total of 2544 patients were identified after full aortic root replacement performed in 101 different hospitals (1999-2024). A total of 249 patients (10%) with primary conotruncal defects included double-outlet right ventricle (n = 14, 6%), pulmonary atresia with ventricular septal defect (n = 42, 17%), transposition of the great arteries (n = 71, 29%), tetralogy of Fallot (n = 88, 35%), and truncus arteriosus communis (n = 34, 14%). Mechanical Bentall was performed in 163 cases (65%), valve-sparing was performed in 43 cases (17%), biological Bentall was performed in 20 cases (8%), and homograft replacement was performed in 23 cases (9%). Conotruncal diagnosis was linked to longer cardiopulmonary bypass times (P < .001), longer aortic crossclamp times (P < .001), longer intensive care unit stay (P < .001), and longer hospital stay (P < .001). Multiple logistic regression revealed duration of cardiopulmonary bypass (P < .001) and conotruncal lesion (odds ratio, 2.1, P = .037) as independent risk factors for hospital mortality. CONCLUSIONS: Among adult patients with congenital heart defects undergoing aortic root replacement, those with conotruncal defects represent a distinct subgroup characterized by a high-risk operative profile.
No takes yet. Share an insight, caveat, or question.
Kari et al. (2026) conducted a cohort in Aortic root replacement in adult congenital heart disease (n=2,544). Conotruncal malformation vs. Non-conotruncal diagnoses was evaluated on Hospital mortality (OR 2.1, p=0.037). In adult congenital heart disease patients undergoing aortic root replacement, an underlying conotruncal diagnosis independently increased the risk of hospital mortality (6% vs 1.5%, OR 2.1).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: