Rastelli procedure

Open heart surgical procedure

Rastelli procedure
Specialty	Cardiology
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The Rastelli procedure is an open heart surgical procedure developed by Italian physician and cardiac surgery researcher, Giancarlo Rastelli, in 1967 at the Mayo Clinic, and involves using a pulmonary or aortic homograft conduit to relieve pulmonary obstruction in double outlet right ventricle with pulmonary stenosis.^[1]

On July 26, 1968, the first successful surgery was carried out at the Mayo Clinic by Dr. Robert Wallace.

Usage

It is used to correct certain combinations of congenital heart defects (CHDs):

dextro-Transposition of the great arteries (d-TGA), or overriding aorta, or double outlet right ventricle (DORV); and
Ventricular septal defect (VSD); and
Right ventricular outflow tract obstruction (RVOTO):^[2]

pulmonary atresia; or
pulmonary stenosis; or
subpulmonary stenosis.

Timing

The Rastelli procedure is typically performed between one and two years of age. Since d-TGA, overriding aorta and DORV are cyanotic heart defects, the child is palliated with a Blalock–Thomas–Taussig shunt in the meantime.

Surgical method

Oxygenated blood is directed from the left ventricle to the aorta using a Gore-Tex patch. The VSD is also sealed with the patch. The pulmonary valve is surgically closed.

From the right ventricle to the pulmonary bifurcation, a synthetic conduit and a valve are constructed, which lets oxygen depleted blood to flow into the lungs for reoxygenation.^[3]

Results

In the last seven years of the study, there were seven early deaths (7%) and no surgical fatalities. Univariable analysis revealed that a straddling tricuspid valve (P =.04) and longer aortic crossclamping periods (P =.04) were risk factors for early mortality.

There were 17 late deaths and a patient who had undergone heart transplantation after an average follow-up of 8.5 years.

44 patients underwent reoperations for conduit stenosis, 11 for left ventricular outflow tract obstruction and 28 for interventional catheterization to alleviate conduit stenosis.

There were nine patients with late arrhythmias and five patients who experienced sudden deaths.

At 5, 10, 15 and 20 years, avoidance of death or transplantation (Kaplan-Meier) was 82 percent, 80 percent, 68 percent and 52 percent, respectively.

At 5, 10 and 15 years of followup, the rates of death or reintervention (catheterization or surgical therapy) were 53 percent, 24 percent and 21 percent, respectively.^[4]

Conclusions

Overall, the Rastelli procedure has a low initial fatality rate.

Conduit blockage, left ventricular outflow tract obstruction and arrhythmia, on the other hand, are linked to significant late morbidity and mortality.^[4]

Almost half of the patients who received the Rastelli operation required heart transplantation or died two decades later.

References

^ Backer, Carl Lewis; Mavroudis, Constantine (2003-08-01). "The Rastelli Operation". Operative Techniques in Thoracic and Cardiovascular Surgery. 8 (3): 121–130. doi:10.1053/S1522-2942(03)00034-7. ISSN 1522-2942.
^ "The Rastelli Procedure for Transposition of the Great Arteries".
^ Tatco, Vincent. "Rastelli procedure | Radiology Reference Article | Radiopaedia.org". Radiopaedia. Retrieved 2021-12-16.
^ ^a ^b Kreutzer, Christian; Vive, Julie De; Oppido, Guido; Kreutzer, Jacqueline; Gauvreau, Kimberlee; Freed, Michael; Mayer, John E.; Jonas, Richard; Nido, Pedro J. del (2000-08-01). "Twenty-five–year experience with Rastelli repair for transposition of the great arteries". The Journal of Thoracic and Cardiovascular Surgery. 120 (2): 211–223. doi:10.1067/mtc.2000.108163. ISSN 0022-5223. PMID 10917934.

Rastelli, G. C.; McGoon, D. C.; Wallace, R. B. (October 1969). "Anatomic correction of transposition of the great arteries with ventricular septal defect and subpulmonary stenosis". The Journal of Thoracic and Cardiovascular Surgery. 58 (4): 545–552. doi:10.1016/s0022-5223(19)42568-3. ISSN 0022-5223. PMID 5387997.

Tests and procedures involving the heart

Surgery

Heart valves and septa	Valve repair Valvulotomy Mitral valve repair Valvuloplasty aortic mitral Valve replacement Aortic valve repair Aortic valve replacement Ross procedure Transcatheter Mitral valve replacement Transcatheter pulmonary valve replacement production of septal defect in heart enlargement of existing septal defect Atrial septostomy Balloon septostomy creation of septal defect in heart Blalock–Hanlon procedure shunt from heart chamber to blood vessel atrium to pulmonary artery Fontan procedure left ventricle to aorta Rastelli procedure right ventricle to pulmonary artery Sano shunt compound procedures for transposition of the great vessels Arterial switch operation Mustard procedure Senning procedure for univentricular defect Norwood procedure Kawashima procedure shunt from blood vessel to blood vessel systemic circulation to pulmonary artery shunt Blalock–Taussig shunt SVC to the right PA Glenn procedure
Cardiac vessels	CHD Angioplasty Bypass/Coronary artery bypass MIDCAB Off-pump CAB TECAB Coronary stent Bare-metal stent Drug-eluting stent Obstacle removal Endarterectomy Atherectomy Bentall procedure Valve-sparing aortic root replacement LeCompte maneuver
Other	Pericardium Pericardiocentesis Pericardial window Pericardiectomy Myocardium Cardiomyoplasty Dor procedure Septal myectomy Ventricular reduction Alcohol septal ablation Conduction system Maze procedure (Cox maze and minimaze) Catheter ablation Cryoablation Radiofrequency ablation Pacemaker insertion S-ICD implantation ICD implantation Cardiac resynchronization therapy Left atrial appendage occlusion Cardiotomy Heart transplantation