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 variou s surgical modalities that have bean evolving for the treatment of ventricu lar septal defect, pulmonary atresia, and major aortopulmonary collateral a rteries. Methods. From 1993 to May 1997, 14 patients (group 1) were treated with sta ged 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 pati ent), of which 3 patients (21%) had final correction. There were two deaths (14%). One patient died of blocked shunt. Another patient who had aneurysm al dilation of homograft tubes that were used for unifocalization died afte r final repair because of low cardiac output. In group 2, 10 patients had t en surgical procedures for complete unifocalization and 9 of 10 (90%) of th em achieved final correction. One patient with low cardiac output in whom w e did not close the ventricular septal defect died (10%) of suprasystemic r ight ventricular pressure. Conclusion. In single-stage complete unifocalization, more patients had fin al 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.