Evolving surgical management for ventricular septal defect, pulmonary atresia, and major aortopulmonary collateral arteries

Background. The purpose of this study was to evaluate the results of various surgical modalities that have bean evolving for the treatment of ventricular septal defect, pulmonary atresia, and major aortopulmonary collateral arteries. Methods. From 1993 to May 1997, 14 patients (group 1) were treated with staged unifocalization through thoracotomies and final repair by midsternotomy. From June 1997 to February 1998, 10 patients (group 2) were treated with midsternotomy, single-stage complete unifocalization, and repair. Results. In group 1, 14 patients had 21 procedures (1.5 procedures per patient), of which 3 patients (21%) had final correction. There were two deaths (14%). One patient died of blocked shunt. Another patient who had aneurysmal dilation of homograft tubes that were used for unifocalization died after final repair because of low cardiac output. In group 2, 10 patients had ten surgical procedures for complete unifocalization and 9 of 10 (90%) of them achieved final correction. One patient with low cardiac output in whom we did not close the ventricular septal defect died (10%) of suprasystemic right ventricular pressure. Conclusion. In single-stage complete unifocalization, more patients had final correction. It reduces the number of operations and hospitalization and hence is more cost effective than multistaged procedures. (Ann Thorac Surg 1999;67:760-4) (C) 1999 by The Society of Thoracic Surgeons.