Staged unifocalization revisited

J Card Surg. 2022 Apr;37(4):967-968. doi: 10.1111/jocs.16296. Epub 2022 Feb 9.


Background: A staged thoracotomy unifocalization approach has not been the dominant option over the past 20 years primarily due to the introduction of midline one-stage complete unifocalization.

Methods: In this issue of the Journal of Cardiac Surgery, van de Woestijne et al. publish their experience over the past 30 years in 39 consecutive patients with "consistent" staged unifocalization through a lateral thoracotomy in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries (PA/VSD/MAPCA).

Results: They report definitive repair completion in 76.3% of the patients and an overall survival after definitive repair of 96% at 20 years despite the study period ranging from 1989 to the present.

Conclusion: Given the multiple variations one could have with PA/VSD/MPACA, a midline unifocalization approach may not always be possible. Surgeons should be familiar with the lateral thoracotomy unifocalization staged approach to PA/VSD/MAPCA.

Keywords: congenital heart disease.

MeSH terms

  • Cardiac Surgical Procedures*
  • Collateral Circulation
  • Heart Septal Defects, Ventricular* / surgery
  • Humans
  • Infant
  • Pulmonary Artery / abnormalities
  • Pulmonary Atresia* / surgery
  • Retrospective Studies