Transposition with ventricular septal defect and pulmonary stenosis: the Rastelli operation

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Transposition of the great arteries with ventricular septal defect and pulmonary stenosis is a complex congenital heart defect.
• The Rastelli operation is a surgical procedure to correct this condition.
• Previous outcomes for younger children indicated higher mortality rates.

Purpose of the Study:

• To describe the evolved surgical technique for the Rastelli operation.
• To report the outcomes of Rastelli operations performed at the Mayo Clinic.
• To compare the success of the Rastelli operation with the repair of tetralogy of Fallot.

Main Methods:

• Review of 52 Rastelli operations performed for transposition of the great arteries with ventricular septal defect and pulmonary stenosis.
• Analysis of mortality rates in patients over four years of age.
• Description of the surgical technique and evolution of the procedure.

Main Results:

• A total of 52 Rastelli operations were performed.
• In 43 patients over four years of age, there were two deaths (5% mortality).
• The evolved surgical technique was described in detail.

Conclusions:

• The Rastelli operation, as performed with the evolved technique, demonstrates a 5% mortality in older children.
• The success of this surgical approach appears comparable to the repair of tetralogy of Fallot.
• A policy of early palliation via Blalock-Taussig shunt for younger children was adopted due to higher earlier mortality.