Long-term results after the Rastelli repair for transposition of the great arteries.
BACKGROUND
This study sought to assess risk factors for late mortality after the Rastelli operation for patients with transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction.


METHODS
Records of 39 patients who underwent the Rastelli operation between 1977 and 2004 were reviewed. Median age at the time of operation was 5.1 years (2.2 years within the last 5 years).


RESULTS
There were no early deaths. During a median follow-up of 8.9 years (range, 0 to 25 years), 2 patients died of sudden death, 1 of pneumonia, 1 during reoperation, and 2 received heart transplantation. Freedom from death or transplantation was 93.8% +/- 4.3% and 57.5% +/- 15.1% at 10 and 20 years, respectively. Freedom from conduit replacement was 48.8% +/- 10.3% and 32.5% +/- 10.3% at 10 and 20 years, respectively. Subvalvular and valvular left ventricular outflow tract obstruction (p = 0.012), stenosis of the peripheral pulmonary arteries (p < 0.001), enlargement of the ventricular septal defect (p = 0.030), and longer ischemic time (p = 0.015) were predictive for death or transplantation. Patients younger than 4 years at the time of the Rastelli operation showed a trend toward a better freedom from death or transplantation (p = 0.068), but needed significantly more conduit replacements (p = 0.038) compared with patients 4 years or older.


CONCLUSIONS
The Rastelli operation is a low-risk procedure with regard to early mortality. The status of the pulmonary arteries and ventricular septal defect enlargement are predictive for long-term survival. Patients 4 years of age or older at the time of the Rastelli operation require fewer reoperations for conduit exchange. Nevertheless, early Rastelli repair is recommended because patients 4 years or older are at risk for a higher long-term mortality.
Hörer
Jürgen
J
Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University, Munich, Germany. hoerer@dhm.mhn.de
Schreiber
Christian
C
Dworak
Eva
E
Cleuziou
Julie
J
Prodan
Zsolt
Z
Vogt
Manfred
M
Holper
Klaus
K
Lange
Rüdiger
R
D000293:Adolescent; D000328:Adult; D013504:Cardiovascular Surgical Procedures / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007223:Infant; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000601:surgery*; D014694:Ventricular Outflow Obstruction / Q000601:surgery*