[Reoperation for obstructed extracardiac conduit after Rastelli operation--an autogenous tissue reconstruction...

Eight patients with a mean age of 13.0 years underwent reoperation for obstructed extracardiac dacron conduit with xenograft valve at a mean of 7 years after Rastelli operation. In two patients, infective endocarditis of the stenotic conduit was the main indication for the reoperation. Diagnoses included 3 tetralogy of Fallot with pulmonary atresia, 3 d-TGA (III), 1 truncus arteriosus, and 1 corrected TGA. The conduit was completely excised leaving the posterior half of the autogenous external peel of conduit as the new outflow bed and a monocusped patch was then placed. Operations were mostly carried out allowing the heart to continue to beat. One patient with c-TGA who underwent concomitant replacement of aortic and left A-V values died in the hospital 4 months postoperatively. In other 7 patients, systolic pressure gradient across the right ventricular outflow decreased from a mean of 80.3 mmHg to 16.0 mmHg. Postoperative pulmonary regurgitation by UCG were trivial in 3 and grade III in 3 patients. One patient required re-reoperation late postoperatively for re-stenosis due to contracture of Golaski outflow patch. Three patients did not require any homologous blood during either the operation or the rest of the hospital stay. The results suggests that this method is a simple and effective option for reoperation of obstructed extracardiac dacron conduits late after Rastelli operation.