{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T01:21:31Z","timestamp":1779931291387,"version":"3.53.1"},"reference-count":20,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2018,11,11]],"date-time":"2018-11-11T00:00:00Z","timestamp":1541894400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Asian Cardiovasc Thorac Ann"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries is a complex form of congenital heart disease. Midline unifocalization has been developed for the surgical treatment of this condition. There are 3 outcome measures that determine long-term success: patients are alive, patients have achieved complete repair (i.e. ventricular septal defect closure), and patients have a relatively low right ventricle-to-aortic pressure ratio (&lt;0.45). However, to date, no studies have combined these 3 outcome measures to analyze the likelihood of achieving an ideal outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective review of 255 patients who underwent midline unifocalization for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries. The median age at unifocalization was 4.5 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Two hundred thirty-five (92%) patients were alive at a mean follow-up of 5.3 years. Two hundred and seventeen (85%) patients underwent single-stage complete repair, and 38 (15%) had an initial unifocalization and shunt. Twenty-four of the 38 palliated patients have subsequently undergone repair. Thus 241 (94%) patients ultimately achieved complete repair. Of the 241 patients who were repaired, 219 (86%) had a right ventricle-to-aortic peak systolic pressure ratio &lt;0.45. Combining these outcome measures, 77% of patients achieved an ideal outcome at one month, 73% at 6 months, 76% at one year, and 80% at 4 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Most (80%) patients can achieve all 3 measures of favorable outcome at 4 years following midline unifocalization. We speculate that this will be a favorable portend for the future of these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0218492318814079","type":"journal-article","created":{"date-parts":[[2018,11,11]],"date-time":"2018-11-11T06:20:33Z","timestamp":1541917233000},"page":"11-17","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Analysis of achieving an \u201cideal\u201d outcome following midline unifocalization"],"prefix":"10.1177","volume":"27","author":[{"given":"Richard D","family":"Mainwaring","sequence":"first","affiliation":[{"name":"Division of Pediatric Cardiac Surgery, Lucile Packard Children\u2019s Hospital Stanford, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William L","family":"Patrick","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiac Surgery, Lucile Packard Children\u2019s Hospital Stanford, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana R","family":"Rosenblatt","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiac Surgery, Lucile Packard Children\u2019s Hospital Stanford, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teimour","family":"Nasirov","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiac Surgery, Lucile Packard Children\u2019s Hospital Stanford, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4700-583X","authenticated-orcid":false,"given":"Komal","family":"Kamra","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiac Anesthesia, Lucile Packard Children\u2019s Hospital Stanford, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank L","family":"Hanley","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiac Surgery, Lucile Packard Children\u2019s Hospital Stanford, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,11,11]]},"reference":[{"key":"bibr1-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2013.10.115"},{"key":"bibr2-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2013.01.007"},{"key":"bibr3-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2012.12.066"},{"key":"bibr4-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.08.082"},{"key":"bibr5-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2016.08.113"},{"key":"bibr6-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.03.110"},{"key":"bibr7-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.03.041"},{"key":"bibr8-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2018.03.153"},{"key":"bibr9-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)34954-2"},{"key":"bibr10-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2017.05.020"},{"key":"bibr11-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1053\/j.pcsu.2017.11.001"},{"key":"bibr12-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2016.07.082"},{"key":"bibr13-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezy017"},{"key":"bibr14-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2014.10.033"},{"key":"bibr15-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2008.01.098"},{"key":"bibr16-0218492318814079","unstructured":"Hofferberth SC, Loh YJ, Baird CW, Mayer JE, del Nido PJ, Emani SM. Pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals: comparison of single-stage versus multi-stage unifocalization strategies (abstract). 2016 Western Thoracic Surgical Association program book, page 134."},{"key":"bibr17-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2013.10.046"},{"key":"bibr18-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezw069"},{"key":"bibr19-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2011.05.010"},{"key":"bibr20-0218492318814079","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-08-0324"}],"container-title":["Asian Cardiovascular and Thoracic Annals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0218492318814079","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0218492318814079","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0218492318814079","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:53:59Z","timestamp":1777398839000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0218492318814079"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11,11]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1177\/0218492318814079"],"URL":"https:\/\/doi.org\/10.1177\/0218492318814079","relation":{},"ISSN":["0218-4923","1816-5370"],"issn-type":[{"value":"0218-4923","type":"print"},{"value":"1816-5370","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11,11]]}}}