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Complete atrioventricular canal repair under 1 year: Rastelli one-patch procedure yields excellent long-term results
Andreea Dragulescu1, Virginie Fouilloux, Olivier Ghez
1Pediatric Cardiology Unit, Children's Hospital, La Timone, Marseille, France.
Insights
The Rastelli one-patch repair is a safe and effective surgical technique for complete atrioventricular canal, demonstrating excellent long-term survival and low rates of reoperation for mitral regurgitation.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Surgical Techniques
Background:
- Evaluating midterm and long-term outcomes of the Rastelli one-patch repair for complete atrioventricular canal.
- Comparing outcomes with recently proposed surgical techniques.
Purpose of the Study:
- To assess the safety and efficacy of the Rastelli one-patch repair in patients with complete atrioventricular canal.
- To analyze midterm and long-term results, including survival and reoperation rates.
Main Methods:
- A cohort of 107 patients with complete atrioventricular canal underwent the Rastelli one-patch procedure between 1984 and 2005.
- Patients were divided into two groups based on the surgical period (1984-1995 and 1995-2005).
- Data collected included patient demographics, associated anomalies, and surgical details, with follow-up for survival and reoperations.
Main Results:
- Early survival was 86%, with 5 early reoperations. Late survival at 10 and 15 years was 84%.
- Freedom from reoperation for mitral regurgitation was high: 94% at 10 years and 91% at 15-20 years.
- At last follow-up, most patients had mild or no mitral regurgitation.
Conclusions:
- The Rastelli one-patch repair is a safe and reproducible technique for complete atrioventricular canal.
- The technique offers very satisfactory freedom from late reoperation for mitral regurgitation among survivors.
- A well-executed Rastelli one-patch technique is comparable to other proposed surgical methods.
Background:
Considering more recently proposed techniques, we have evaluated our midterm and long-term results of Rastelli one-patch repair in complete atrioventricular canal.
Methods:
Between 1984 and 2005, 107 patients with a complete atrioventricular canal underwent a Rastelli one-patch procedure. Two groups were identified: 1984 to 1995 and 1995 to 2005 (respectively, 56 and 51 patients). Mean age at surgery was 5.3 +/- 3.4 months; mean weight was 5.5 +/- 3 kg; trisomy 21 was present in 81 patients; complete atrioventricular canal type A was found in 67 patients, type C in 40 patients. There were 12 cases of potentially parachute mitral valve and 14 associated anomalies treated simultaneously (pulmonary obstruction 11, coarctation 3). The coronary sinus was always left on the right side. After functional and anatomic evaluation, the cleft was closed completely in 8 and partially in 29, and was left intact in 70 cases.
Results:
Early survival was 86% +/- 3%. Five patients underwent early reoperation for residual ventricular septal defect (n = 2) and mitral valve repair (n = 3). Nine patients underwent late reoperations with successful repair: subaortic stenosis (n = 4) and mitral valve repair (n = 5). Late survival at 10 and 15 years was 84% +/- 3%. Freedom from reoperation for mitral regurgitation was 94% +/- 3% at 10 years, and 91% +/- 3% at 15 and 20 years. At last follow-up 30 patients had mild and 3 had moderate mitral regurgitation.
Conclusions:
Rastelli single-patch repair in complete atrioventricular canal is a safe and reproducible technique. Among survivors, freedom from late reoperation for mitral regurgitation is very satisfactory. A properly taught, learned, and transmitted Rastelli one-patch technique compares very well with any other proposed technique.
