The Rastelli operation for transposition of the great arteries. Early and late results

Fifty-nine patients had corrective operation of the Rastelli type for transposition of the great arteries between 1968 and 1975. In 121 patients (35 per cent), the ventricular septal defect was enlarged by excising a portion of the septum. During the first 30 days after the operation, II patients (19 per cent) died. The risk of repair in infancy was greatly increased. There were 5 late deaths, and reoperation was required in 11 patients. Sixty-eight per cent of the survivors are in New York Heart Association Class I and 29 per cent are in Class II. Some late complications related to deteriorations of the earlier aortic homograft conduit may be avoided by use of a Dacron conduit with a porcine valve, as suggested by short-term favorable results in 25 recent cases. The current operative mortality rate of 8 per cent (last 25 operations) and the observation that all but one of the late survivors in this series are either asymptomatic or only mildly symptomatic tend to verify the Rastelli operation as the procedure of choice for repair of transposition of of the great arteries when associated with ventricular septal defect and pulmonary stenosis.