Introduction
During the last 30 years the surgical strategy for pulmonary atresia (PA) with ventricular septal defect (VSD) and systemic-pulmonary collateral arteries (SPCA’s) is subject of ongoing discussion. There are several reports using the multi-staged approach as well as reports on two-staged approach or one-stage midline primary repair. [1-6] Furthermore it has been reported that unifocalization possibly does not bring long-term benefit in terms of late survival.[7]
Historically patients with PA, VSD and SPCA’s were treated in our hospital with various surgical interventions depending on the clinical condition and previous cardio-surgical procedures on presentation in our clinic. Since 1989 a protocol as described previously was followed in all our patients presenting with PA, VSD and SPCA’s.[8] This protocol consisted of staged unifocalization procedures with a subsequent total correction, with closure of the VSD and placing a pulmonary homograft between the right ventricular outflow tract (RVOT) and the pulmonary bifurcation. We report our results of 30 year experience with this staged protocol applied to all consecutive patients.