Comparison for Long-Term Results of the Modified Réparation à l´étage Ventriculaire and Rastelli Repair

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Complex congenital heart defects, including transposition of the great arteries and double outlet ventricles, often require surgical intervention.
• Ventricular septal defect (VSD) and pulmonary outflow tract obstruction present significant challenges in surgical repair.
• Ventriculoarterial discordance necessitates specialized surgical techniques for correction.

Purpose of the Study:

• To compare the long-term efficacy of a modified réparation à l'étage ventriculaire (REV) versus the Rastelli repair.
• To evaluate survival, arrhythmia-free survival, and reoperation rates in patients undergoing these procedures.
• To identify the primary reasons for reoperation following each surgical approach.

Main Methods:

• A retrospective study of 100 consecutive patients with VSD and pulmonary outflow tract obstruction without ventriculoarterial concordance.
• Patients were divided into two groups: modified REV (n=50) and Rastelli repair (n=50).
• Long-term outcomes including survival and reoperation rates were analyzed.

Main Results:

• Both modified REV and Rastelli repair demonstrated satisfactory long-term survival rates.
• Reoperation-free survival was significantly better after the modified REV compared to the Rastelli repair.
• Common reoperation causes after Rastelli repair included pulmonary stenosis and arrhythmia, while pulmonary regurgitation was more frequent after modified REV.

Conclusions:

• Modified REV and Rastelli repair offer viable long-term solutions for complex congenital heart defects.
• The Rastelli repair is associated with a higher likelihood of reoperations, particularly for biventricular outflow tract obstruction and arrhythmias.
• The modified REV appears to reduce the need for repeat surgeries compared to the Rastelli repair.