A review of surgical and anesthetic techniques used in 44 consecutive patients to establish continuity between the right ventricle and pulmonary circulation, without extracorporeal circulation, as a first-stage repair in a variety of selected complex congenital cardiac lesions with right ventricular outflow obstruction, is presented. The overall operative mortality rate was 9% (four deaths), but no deaths occurred in the last 24 patients. Eleven patients (27.5%) have subsequently undergone complete repair and one patient (2.5%) underwent a Fontan repair. The advantages, anesthetic concerns, complications, and outcome are discussed.
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