Experiences on surgical treatment for pulmonary atresia with ventricular septal defect: analysis of surgical results of 270 cases

Abstract

Objective To summarize surgical experiences of 270 cases with pulmonary atresia and ventricular septal defect ( PA/VSD),we sought to analyze operative results.Methods The clinical data of 270 patients consecutively operated on from Jan,1999 to Sep,2009 were retrospectively reviewed.There were 114 cases with 237 major aortopulmonary collateral arteries (MAPCAs) and 150 MAPCAs in 86 cases had been managed.143 patients with Nakata index ( 107.57 ± 58.06) mm2/m2 (21.79 mm2/m2 ～ 367.82 mm2/m2 ) in first operations received 166 palliative operations and 39 cases already received repair operations.127 cases with Nakata index (219.89 ± 99.56 ) mm2/m2 (50.82 mm2/m2 ～ 575.82 mm2/m2 ) received onestage complete repair procedures.Results Total post-operative in-hospital mortality was 12.2％ (33/270),mortality declined from 19.7％ (24/122) before 2005 to 6.1％ (9/148) after 2005.The in-hospital mortality postoperatively in palliative group and in one-stage complete repair group were 7.7％ (11/143),14.2％ (18/127),respectively and mortality declined from 9.8％ (7/71) before 2005 to 5.5％ (4/72) after 2005 in palliative group while from 20.6％ (14/68) before 2005 to 6.8％ (4/59) after 2005 in one-stage complete repair group.Low cardiac output syndrome,perfusion lungs after operations and pulmonary artery unifocalizations ( relative coefficient was 3.794,4.394,3.746,respectively and OR was 44.424,80.990,42.338,respectively) were risk factors relative to in-hospital mortality in palliative group.Perfusion lungs after operations,septum fenestration at the end of operations,pulmonary artery unifocalizations,taking HTK solution as cardioplegia combined with zero equilibrium ultrafiltration (relative coefficient was 1.871,0.367,2,428,-2,004,respectively and OR was 6.493,1.443,11.336,0.135,respectively) were risk factors relative to in-hospital mortality in one-stage complete repair group.Conclusion The mortality of patients with PA/VSD received surgical procedures was significantly decreased after 2005,either in palliative group or in one-stage complete repair group.Low cardiac output syndrome,perfusion lungs after operations and pulmonary artery unifocalizations increased mortality in palliatiye groui.Perfusion lungs after operations,septum fenestration,pulmonary artery unifocalizations increased mortality in one-stage complete repair group while taking HTK solution as cardioplegia combined with zero equilibrium ultrafiltration decreased mortality. Key words: Pulmonary atresia; Ventricular septal defect; Cardiac surgical procedures