Boston - American Association for Thoracic Surgery

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89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS52. Unifocalisation of Major Aortopulmonary Arteries in PulmonaryAtresia with Ventricular Septal Defect Is Essential to AchieveExcellent Outcomes Irrespective of Native Pulmonary ArteryMorphologyBen Davies, 1 Shafi Mussa, 1 Paul Davies, 2 John Stickley, 1 John G. Wright, 1Joseph V. de Giovanni, 1* Oliver Stümper, 1 Rami Dhillon, 1 Timothy J. Jones, 1David J. Barron, 1 William J. Brawn 11. Department of Cardiac <strong>Surgery</strong>, Birmingham Children’s Hospital, Birmingham,United Kingdom; 2. Institute of Child Health, University of Birmingham,Birmingham, United KingdomInvited Discussant: Christian BrizardOBJECTIVE: Pulmonary atresia with ventricular septal defect and major aortopulmonarycollaterals (MAPCAs) is a complex lesion with a high rate of naturalattrition. We evaluated the outcomes of our strategy of unifocalisation in the managementof these patients.METHODS: From 1989 to 2008, 236 patients (109 male) entered a pathway aiming<strong>for</strong> complete repair by unifocalising major aortopulmonary arteries to an RV-PAconduit with VSD closure. Where ventricular septation was not possible, definitiverepair was considered to include pulmonary artery reconstruction and a limitingRV-PA conduit or systemic shunt. Native pulmonary artery morphology was classifiedinto confluent intrapericardial (n = 154), confluent intrapulmonary (n = 54)and non-confluent intrapulmonary (n = 28).* AATS Member192
AMERICAN ASSOCIATION FOR THORACIC SURGERYRESULTS: Follow-up was 94% complete. 30-day and late mortality after definitivesurgery in all 236 patients was 6% (n = 13) and 6% (n = 14), respectively. Overallsurvival was 89% at 3 years following definitive repair. 203 patients (85%) haddefinitive repair at a median age of 2.0 years. There was no significant difference insurvival following complete repair between patients from any of the three morphologicalpulmonary artery groups (P = 0.18). 132 (56%) patients had complete repairwith VSD closure, as a single or staged procedure in 111 and 21 patients, respectively.Focalisation of MAPCAs with proven long-term patency with the RV wasassociated with a survival benefit compared to 14 patients in whom unifocalisationwas not possible and had only systemic shunts. In the follow-up period, 190patients required 196 catheter and 60 surgical re-interventions.CONCLUSION: Using a strategy of unifocalisation, intrapericardial pulmonaryartery reconstruction and RV-PA conduit, excellent long-term survival can beachieved in this group of patients even in the absence of native intrapericardialpulmonary arteries.TUESDAYAfternoon193
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Boston - American Association for Thoracic Surgery

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