title: Postoperative Outcomes of Children With Tetralogy of Fallot, Pulmonary Atresia, and Major Aortopulmonary Collaterals Undergoing Reconstruction of Occluded Pulmonary Artery Branches.
abstract: BACKGROUND
  Patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals (TOF/PA/MAPCAs) undergoing unifocalization surgery are at risk for prolonged postoperative respiratory failure. We sought to understand whether patients undergoing reconstruction and incorporation of occluded pulmonary arterial branches were at risk for worse postoperative outcomes.
  
  
  METHODS
  We performed a retrospective chart review to identify patients who underwent unifocalization or unifocalization revision with incorporation of occluded pulmonary artery branches. Patients with and without occluded branches were compared, with a focus on clinical outcomes.
  
  
  RESULTS
  We studied 92 patients who underwent unifocalization procedures between 2010 and 2014, 17 (18%) of whom underwent reconstruction of occluded pulmonary artery branches. Patients with occluded vessels were more likely to require staged unifocalization procedures, although more than two thirds of this cohort eventually underwent complete intracardiac repair. Durations of mechanical ventilation, intensive care, hospital stay, and the need for early reoperation were similar between the two groups.
  
  
  CONCLUSIONS
  Occluded pulmonary arterial branches can be safely recruited into the pulmonary vasculature in patients with TOF/PA/MAPCAs without a significant difference in postoperative outcomes compared with patients who did not have an occluded branch. Incorporation of occluded branches may also facilitate ultimate complete intracardiac repair in this complex population of patients.
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California. Electronic address: rasija@stanford.edu.
authors.forename: Ritu
authors.initials: R
authors.lastname: Asija
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Koth
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Nathalia
authors.initials: N
authors.lastname: Velasquez
authors.affiliation: Department of Radiology, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Frandics P
authors.initials: FP
authors.lastname: Chan
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Stanton B
authors.initials: SB
authors.lastname: Perry
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Hanley
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Doff
authors.initials: D
authors.lastname: McElhinney
mesh_terms: D000293:Adolescent; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation; D000072226:Computed Tomography Angiography; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D018633:Pulmonary Atresia / Q000601:surgery*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D016037:Single-Blind Method; D013771:Tetralogy of Fallot / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult