Consensus document on optimal management of patients with common arterial trunk

Introduction

Congenital heart disease comprises a broad field with many different diagnoses and wide-ranging anatomical variations of all kinds. This enormous variation is probably responsible for the relative lack of guidelines and consensus documents on the subject, especially when compared with structural ‘adult’ heart disease.

Nevertheless, guidelines and consensus documents are important because their intention is to optimize decision-making based on a critical review of the literature, including the most recently published papers, and on the personal experience of professionals in the field. This consensus document on the common arterial trunk (CAT) has been compiled by task force members of the European Association for Cardio-Thoracic Surgery (EACTS) and the Association for European Paediatric and Congenital Cardiology (AEPC). Task force members were chosen according to their specific expertise with the goal of being able to encompass the full spectrum of CAT. The members of the task force have given a full disclosure of any conflicts of interests and relations with industry. There are no known conflicting interests or relations with industry that might have influenced the recommendations in this document.

The authors of this document have strictly adhered to the Methodology Manual for EACTS Clinical Guidelines that was published in 2015 [1]. The task force has performed a complete review of the existing literature, and all available data were carefully weighed to determine their usefulness to construct recommendations and statements. There are no randomized or prospective studies on CAT, and most of the available literature consists of retrospective patient series (with a few multicentre studies being the exception). High-level evidence is therefore not readily available and most evidence is level C (Table 1).

Because this is a consensus paper, recommendations are often not backed by strong evidence. Therefore, the task force has chosen to limit the number of recommendations (Table 2) and instead to make statements intended to assist and facilitate clinical decision-making.

The task force has aimed for completeness by including all relevant topics related to the management of CAT. In rare cases of CAT, ventricular hypoplasia is present, which precludes the construction of a biventricular circulation. Forms of CAT with hypoplasia of 1 of the ventricles are sometimes named here when relevant, but, because the management is typically completely different, they are not topics of this consensus document.