Unifocalization with pericardial roll technique in pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries

Abstract

Objective This study aims to compare both the pericardial roll technique with the patch augmentation technique of the unifocalization, and single‐stage complete repair with the unifocalization and shunt for the repair of the ventricular septal defect, pulmonary atresia, and major aortopulmonary collateral arteries. Methods This was a retrospective review of the 48 patients undergoing unifocalization of the ventricular septal defect, pulmonary atresia, and major aorticopulmonary collateral arteries from a single center. Our cohort had two surgical pathways, including single‐stage midline unifocalization (n = 40), unifocalization after pulmonary artery rehabilitation by creating an aortopulmonary window or central shunt (n = 8). There were two surgical techniques in single‐stage midline unifocalizaton, including widening of the pulmonary arteries with a patch (n = 30), and connecting pulmonary arteries with a pericardial roll (n = 10). Results A total of 14 (29.2%) of 48 patients underwent single‐stage complete repair, 26 patients underwent shunt palliation with unifocalization. Combined early and late mortality was seen in seven patients in those who underwent shunt palliation with unifocalization, while it was seen in one patient in those who underwent a single‐stage complete repair (mortality ratio 26.8% vs. 7.1%, p = .22). There was no statistically significant difference between the pericardial roll and patch augmentation techniques in terms of pulmonary artery reintervention (p = .65). Although all pulmonary artery reinterventions were for unilateral pulmonary artery in the roll technique group, 41.7% of reinterventions were for bilateral pulmonary arteries in the pericardial augmentation group. Conclusion Single‐stage complete repair of the ventricular septal defect, pulmonary atresia, and major aorticopulmonary collateral arteries has better results than unifocalization with a shunt. In terms of nonvaluable raw material, the use of the pericardial roll technique is a considerable alternative for unifocalization.

Commentary: Should we “keep rollin'” for PA/VSD/MAPCA?

“…In this month's Journal , Onalan et al 1 report on a retrospective, single‐center cohort study of patients undergoing unifocalization of pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries. A total of 48 patients were included from 2015 to 2021, 14 (29.2%) of which underwent single‐stage complete unifocalization, 26 (54.1%) unifocalization with concomitant systemic to pulmonary artery shunt placement with subsequent consideration for complete repair, and 8 underwent initial systemic‐pulmonary or aortopulmonary window creation without concomitant unifocalization.…”

Pulmonary flow-study can predict in-hospital prognosis of unifocalization and corrective repair of pulmonary atresia/ventricular septal defect with major aortopulmonary collateral arteries

“…It is important to assess the adequacy of pulmonary vasculature and right ventricle afterload, by using schemes for objectively measuring, such as total neo-pulmonary artery index (TNPAI) [ 4 ] and the ratio of right ventricle systolic pressure and systolic blood pressure (RVSP: SBP) [ 5 ]. The pre-operative TNPAI≥150 mm 2 /m 2 and post-operative RVSP: SBP≤0.7–0.8 were considered as indicators to close VSD.…”