Surgical management of tricuspid malinsertion in the Rastelli operation: conal flap method

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Complete transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary stenosis/atresia requires complex surgical repair.
• The Rastelli operation is a standard procedure for TGA with VSD and pulmonary stenosis.
• Tricuspid valve involvement can complicate the Rastelli procedure, necessitating modifications.

Purpose of the Study:

• To compare the outcomes of the conventional Rastelli procedure versus a modified conal flap method in patients with TGA, VSD, and pulmonary stenosis/atresia.
• To evaluate the impact of tricuspid valve chordae mobilization on right heart function and tricuspid regurgitation.

Main Methods:

• Retrospective analysis of 25 patients undergoing the Rastelli operation between June 1986 and May 1994.
• Patients were divided into a conventional group (normal tricuspid valve chordae) and a conal flap group (tricuspid malinsertion treated with chordae mobilization).
• Comparison of early and late mortality, reoperation rates, functional class, and echocardiographic/catheterization data.

Main Results:

• No early deaths in the conal flap group versus one in the conventional group. Overall mortality was similar between groups.
• All patients achieved New York Heart Association functional class I at follow-up.
• Mild to moderate tricuspid regurgitation was observed in both groups, with no significant differences in postoperative right heart catheterization data.

Conclusions:

• The Rastelli operation with the conal flap method is a safe and effective alternative for TGA patients with tricuspid valve involvement.
• Mobilization of tricuspid valve chordae does not appear to adversely affect right heart function or lead to significantly increased tricuspid regurgitation compared to the conventional approach.