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Objectives: To assess the predictive value of preoperative cardiac CT angiography (CTA) for survival in patients with pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA-VSD-MAPCAs). Methods: We retrospectively analysed PA-VSD-MAPCA patients with preoperative CTA who underwent both right ventricular outflow tract reconstruction (RVOTR) and MAPCA unifocalization (n=24) or reservation (n=28). Prognostic values of CTA were assessed using Cox univariate and multivariate analyses. The significant threshold of independent parameters was calculated using receiver operating characteristic (ROC) curves.Results:Multivariate analysis identified that a high pulmonary vein index (PVI) (hazard ratio HR = 0.994; 95% confidence interval [CI]: 0.989, 0.999; P=0.024) and the presence of native pulmonary artery (NPA) (HR=0.121; 95% CI: 0.028, 0.519; P=0.004) were independent positive predictors of better survival. The area under the ROC curve for PVI was 0.789 (P=0.002), and a cut-off point of 437.67 mm2/m2 was deemed as the significant threshold for survival (sensitivity 92.3%, specificity 71.8%).Conclusions:Preoperational high PVI and NPA presence were significant morphologic predictors of a positive survival advantage in PA-VSD-MAPCA patients. A PVI greater than 437.67 mm2/m2 may be a reliable positive prognosticator that could improve the decision-making strategy for PA-VSD-MAPCA patients.