Saline inflation-assisted unifocalization for pulmonary atresia with ventricular septal defect and major...

Unifocalization for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries remains challenging due to vascular heterogeneity. This study evaluated the outcomes of a saline inflation-assisted unifocalization technique used to visually guide anastomosis site selection.

This retrospective, single-center study included 30 consecutive patients undergoing unifocalization between 2017 and 2023. The surgical protocol integrated dissection of major aortopulmonary collateral arteries and parenchymal pulmonary arteries, saline inflation to visually guide pulmonary reconstruction, and an intraoperative pulmonary flow study to assess suitability for ventricular septal defect closure. Outcomes analyzed were ventricular septal defect closure, survival, and catheter-based reintervention.

Among 27 survivors, 100% ultimately achieved ventricular septal defect closure (63% primary, 37% staged). Early mortality was 10%, confined to patients with 22q11 deletion. Flow study values correlated with the number of anastomoses (r = 0.65, P < .001). One-year freedom from catheter-based reintervention was 45%, mainly balloon angioplasty for anastomotic stenosis. No surgical reinterventions were required after ventricular septal defect closure. Homograft augmentation was associated with lower postoperative right ventricular pressure than autologous pericardium (P = .03).

Saline inflation-assisted unifocalization provided visual guidance for anastomosis site selection and demonstrated acceptable midterm results in this cohort. This technique may serve as a practical adjunct in major aortopulmonary collateral arteries repair, and further evaluation is warranted to clarify its role and long-term durability.