{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:55:00Z","timestamp":1792180500595,"version":"4.4.0"},"reference-count":24,"publisher":"Cambridge University Press (CUP)","issue":"9","license":[{"start":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T00:00:00Z","timestamp":1530835200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"},{"start":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T00:00:00Z","timestamp":1530835200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["www.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S104795111800080X_abs1\" sec-type=\"intro\"><jats:title>Introduction<\/jats:title><jats:p>The optimal approach to unifocalisation in pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (pulmonary artery\/ventricular septal defect\/major aortopulmonary collaterals) remains controversial. Moreover, the impact of collateral vessel disease burden on surgical decision-making and late outcomes remains poorly defined. We investigated our centre\u2019s experience in the surgical management of pulmonary artery\/ventricular septal defect\/major aortopulmonary collaterals.<\/jats:p><\/jats:sec><jats:sec id=\"S104795111800080X_abs2\" sec-type=\"materialsandmethods\"><jats:title>Materials and methods<\/jats:title><jats:p>Between 1996 and 2015, 84 consecutive patients with pulmonary artery\/ventricular septal defect\/major aortopulmonary collaterals underwent unifocalisation. In all, 41 patients received single-stage unifocalisation (Group 1) and 43 patients underwent multi-stage repair (Group 2). Preoperative collateral vessel anatomy, branch pulmonary artery reinterventions, ventricular septal defect status, and late right ventricle\/left ventricle pressure ratio were evaluated.<\/jats:p><\/jats:sec><jats:sec id=\"S104795111800080X_abs3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Median follow-up was 4.8 compared with 5.7 years for Groups 1 and 2, respectively, p = 0.65. Median number of major aortopulmonary collaterals\/patient was 3, ranging from 1 to 8, in Group 1 compared with 4, ranging from 1 to 8, in Group 2, p = 0.09. Group 2 had a higher number of lobar\/segmental stenoses within collateral vessels (p = 0.02). Group 1 had fewer catheter-based branch pulmonary artery reinterventions, with 5 (inter-quartile range from 1 to 7) per patient, compared with 9 (inter-quartile range from 4 to 14) in Group 2, p = 0.009. Among patients who achieved ventricular septal defect closure, median right ventricle\/left ventricle pressure was 0.48 in Group 1 compared with 0.78 in Group 2, p = 0.03. Overall mortality was 6 (17%) in Group 1 compared with 9 (21%) in Group 2.<\/jats:p><\/jats:sec><jats:sec id=\"S104795111800080X_abs4\" sec-type=\"discussion\"><jats:title>Discussion<\/jats:title><jats:p>Single-stage unifocalisation is a promising repair strategy in select patients, achieving low rates of reintervention for branch pulmonary artery restenosis and excellent mid-term haemodynamic outcomes. However, specific anatomic substrates of pulmonary artery\/ventricular septal defect\/major aortopulmonary collaterals may be better suited to multi-stage repair. Preoperative evaluation of collateral vessel calibre and function may help inform more patient-specific surgical management.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s104795111800080x","type":"journal-article","created":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T10:15:49Z","timestamp":1530872149000},"page":"1091-1098","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":14,"title":["Pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals: collateral vessel disease burden and unifocalisation strategies"],"prefix":"10.1017","volume":"28","author":[{"given":"Sophie C.","family":"Hofferberth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse 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