Rastelli Operation for D-Transposition of the Great Arteries, Ventricular Septal Defect, and Pulmonary Stenosis

Abstract

Objectives: Our preferred approach for the surgical treatment of patients with D-transposition of the great arteries, ventricular septal defect, and pulmonary stenosis has been the Rastelli operation. We herein evaluate our 30-year experience with this procedure. Methods: Clinical records for patients who underwent the Rastelli operation between 1988 and 2017 at our institution were retrospectively reviewed. Primary outcomes included freedom from death or cardiac transplantation and freedom from conduit reintervention. Results: Forty-seven patients met inclusion criteria. Mean follow-up was 11.7 + 6.8 years. Forty-three (91.5%) patients received a palliative systemic-to-pulmonary artery shunt and/or atrial septostomy prior to the Rastelli procedure. Five (10.6%) patients required ventricular septal defect enlargement at the time of the Rastelli procedure. The overall mean right ventricle-to-pulmonary artery conduit size was 17.0 mm. Mortalities included one early and three late deaths. Freedom from death or cardiac transplantation was 93% and 84% at 5 and 25 years, respectively. Seven patients required pacemaker placement, two immediately postoperatively and five late. Freedom from conduit replacement was 85% and 25% at 5 and 15 years, respectively. Seven (14.9%) patients required a second conduit intervention. Forty-one (87.2%) patients were New York Heart Association class I or II at the most recent follow-up. Conclusions: The Rastelli operation for D-transposition of the great arteries, ventricular septal defect, and pulmonary stenosis offers excellent mid-to long-term survival. The need for conduit replacement remains the most common indication for reintervention, and further study of the optimal choice of conduit will be useful.

Rastelli procedure in transposition of the great arteries associated with ventricular septal defect and pulmonary stenosis: A report of 3 consecutive cases in Cho Ray hospital

“…A restrictive VSD can limit blood flow of LVOT. In some situations, with small VSD, surgeons may enlarge VSD by incising upper-anteriorly [7,8]. In this report, VSD diameter ranges from 9-18mm so it is large enough and does not need to incise.…”

“…The Vietnamese Journal of Cardiovascular and Thoracic Surgery Vol.38 -7/2022 many cardiac surgery centers, about 6% in the first 5-year, decreasing along with the increasing of experience in both surgical technique and intensive care [7].…”

“…Huang and colleagues reported about 15% of patients have to replace conduit 5 years after RO [7]. Conduit sizing based on the body surface area is very important that relates reoperation.…”

“…Rastelli procedure has been reported as the safe and effective operation with low mortality [6,7]. However, Rastelli procedure is a complex cardiac surgery and it is only performed at some profesional Heart center in Vietnam.…”

Case report: successful emergent transcatheter pulmonary valve replacement within failing pulmonary artery conduit in the setting of cardiogenic shock with extracorporeal membrane oxygenation support

“…While advancements in surgical techniques have resulted in excellent long-term outcomes, conduit stenosis remains the most common indication for re-intervention. 1–3 This case demonstrates the consequences of severe conduit stenosis if left untreated leading to severe biventricular failure and cardiogenic shock. The case also stresses the importance of regular follow-up in specialty clinics for patients with congenital heart disease as they grow older, which could have prevented such a critical presentation.…”