Rastelli repair: impact of a remote ventricular septal defect on outcome

  • Dr Claudia Villalba, Argentina
  • Dr Marcela Woloszyn, Hospital de pediatría J.P. Garrahan, Argentina
  • Dr Mariela Mouratian, Hospital de pediatría J.P. Garrahan, Argentina
  • Dr Jorge Barreta, Hospital de pediatría J.P. Garrahan, Argentina
  • Dr Horacio Faella, Hospital de pediatría J.P. Garrahan, Argentina
  • Dr Juan Laura, Hospital de pediatría J.P. Garrahan, Argentina
  • Dr Horacio Capelli, Hospital de pediatría J.P. Garrahan, Argentina

    • Objective: To evaluate the impact of the anatomic localization of ventricular septal defect (VSD) on the Rastelli procedure.
    Methods: 47 patients(pts) after a Rastelli procedure were studied during a follow-up period X:6 years(ys).
    The VSD was related to the great arteries in 29, Group I, and it was a remote defect in 18, Group II.
    Results: 22 pts required 27 new surgical procedures after a follow-up period of X:3 ys. The right ventricle to pulmonary artery conduit was replaced in 12 pts at X:5 ys.
    A VSD had to be closed in 13 pts at X: 1 month. It was a remote septal defect in 11pts p 0.001.
    A subaortic stenosis was relieved in 6 pts at X: 5 years. Four were in group II p 0.31
    Overall mortality was 17.2 %(8pts). Seven of them had a remote VSD p 0.003. Five pts died at X: 5 m after the inicial operation
    During the same period 5 pts were referred for a Nikaido procedure. Four had a remote VSD. All survived and none required a redo after 3 years of follow–up.
    Conclusions: In the Rastelli procedure, the presence of a remote VSD predisposed to:
    • Higher rate of early reoperation p 0.05
    • Higher mortality rate p 0.003
    • In this complex subset of pts, the Nikaido operation or a univentricular approach may be a better surgical option.