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Surgical management of pulmonary atresia with ventricular septal defect: early total correction versus shunt

Jae Gun Kwak1, Chang-Ha Lee, Cheul Lee

  • 1Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Gyeonggi Do, Republic of Korea.

The Annals of Thoracic Surgery
|April 13, 2011
PubMed

Insights

Early total correction for pulmonary atresia with ventricular septal defect is acceptable, avoiding interstage deaths and reducing reoperations, despite a challenging postoperative course. Overall survival rates were similar to shunt operations.

Area of Science:

  • Pediatric Cardiac Surgery
  • Congenital Heart Defects
  • Surgical Outcomes Research

Background:

  • Surgical strategy for pulmonary atresia with ventricular septal defect shifted from shunt operation to early total correction in 2004.
  • This study compares surgical outcomes between shunt and early total correction strategies.

Purpose of the Study:

  • To compare the surgical outcomes of palliative shunt operations versus early total correction in patients with pulmonary atresia with ventricular septal defect.
  • To evaluate mortality, reoperation rates, and postoperative recovery between the two surgical approaches.

Main Methods:

  • Retrospective study of 47 patients with pulmonary atresia with ventricular septal defect (no major aortopulmonary collateral arteries) from 1997-2008.
  • Patients were divided into two groups: 29 undergoing palliative shunt (group S) and 18 undergoing early total correction (group T).
  • Group T patients were significantly younger at surgery (23.2 days) compared to group S (40.1 days).

Main Results:

  • Overall survival rates were similar between groups (p=0.3).
  • Group S had higher reoperation rates (p<0.0001), while group T had higher reintervention rates (p=0.006).
  • Group T experienced longer ventilator support time (p=0.016), but avoided interstage deaths seen in group S.

Conclusions:

  • Early total correction for pulmonary atresia with ventricular septal defect yields acceptable midterm results.
  • While associated with a more complex postoperative course and higher reintervention rates, early total correction eliminates interstage mortality and reduces reoperation needs compared to shunt procedures.
  • The shift in surgical strategy demonstrates a viable alternative with comparable overall survival to traditional shunt operations.
Abstract

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