title: Surgical management of pulmonary atresia with ventricular septal defect: early total correction versus shunt.
abstract: BACKGROUND
  We changed our surgical strategy for pulmonary atresia with ventricular septal defect from shunt operation to early total correction as an initial procedure since 2004. The objective of this study was to compare the surgical outcomes of shunt and early total correction.
  
  
  METHODS
  From 1997 to 2008, 47 patients with pulmonary atresia with ventricular septal defect and no major aortopulmonary collateral arteries who underwent surgical correction were enrolled in this retrospective study. Twenty-nine patients underwent palliative shunt operation (group S) and 18 patients underwent early total correction (group T). The patients in group T were younger than that of group S (23.2±12.6 vs 40.1±23.3 days; p=0.008).
  
  
  RESULTS
  There were 3 operative mortalities in group S and 1 operative mortality in group T. Four interstage deaths in group S and 1 late death in group T occurred. There was no difference in the overall survival rate between the 2 groups (p=0.3). The reoperation rate was higher in group S (p<0.0001) and the reintervention rate was higher in group T (p=0.006). The ventilator support time (5.5±5.1 vs 4.2±5.6 days; p=0.016) and intensive care unit stay (20.3±25.5 vs 15.5±16.0 days; p=0.233) were longer in group T. The preoperative age, body weight, and pulmonary artery size were not associated with the prolonged ventilator support time in group T. The patients who had received preoperative ventilator care showed tendency of prolonged postoperative ventilator support time (p=0.004).
  
  
  CONCLUSIONS
  The midterm results of early total correction for pulmonary atresia with ventricular septal defect are acceptable. Despite a difficult postoperative course, there was no difference in the mortality compared with shunt operation. Although the reintervention rate was higher in the early total correction group, we were able to avoid interstage mortalities that occurred in the shunt group, and we reduced the reoperation rate in the early total correction group.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Gyeonggi Do, Republic of Korea.
authors.forename: Jae Gun
authors.initials: JG
authors.lastname: Kwak
authors.forename: Chang-Ha
authors.initials: CH
authors.lastname: Lee
authors.forename: Cheul
authors.initials: C
authors.lastname: Lee
authors.forename: Chun Soo
authors.initials: CS
authors.lastname: Park
mesh_terms: D006345:Heart Septal Defects, Ventricular / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010166:Palliative Care; D011183:Postoperative Complications / Q000209:etiology; D018633:Pulmonary Atresia / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies