Rastelli operation in which right ventricle (RV) and pulmonary artery (PA) is connected with an artificial graft is effective in increasing the pulmonary blood flow in certain types of congenital heart disease but, in many, it requires a
reoperation
because of the relative stenosis of graft that develops as the patients become old. The purpose of this study is to evaluate the various factors which many influence the long term outcome of such patients following a Rastelli operation.
A total of 47 patients underwent a Rastelli operation during a 15 year period between November, 1978 and October 1993. The mean follow-up period is 76.1*51.3 months.
1. Among the 47 patients, a valved conduit was used in 30 (63.8%), and non-valved conduit in 17.2%) patients. In the 8 patients (17.0%) who died postoperatively, a valved conduit was used in 5 (16.6%) and a non-valved conduit in 3 (17.6%). There
was no
statistical difference in mortality between the 2 groups. There was a good linear correlation between the body surface area (X) and the conduit size (y) (Y=3.86X+14.5, R=0.55, P=0.01).
2. Ten patients underwent replacement of the conduit during the follow-up period. The type of conduit used and the frequency of subsequent replacement were as follows : Ionescu-Shiley, valved-33.3%, Carpentier-Edwards, valved-30.8%, Hancock,
valved-80%
and non-valved conduit-9.1%. The median period free of reoperation was 110 months for the valved and 79 months for the nonvalved group, there being no statistical difference between the 2 groups.
3. The patients who did not require reoperation are all doing well (New York Heart Association Functional Classification : Class Ⅰ). Pressure gradient between the RV and the PA was 20* mmHg in 10 randomly selected patients who did not require
reoperation and 92* mmHg in 10 patients who did require reoperation.
4. The 10 patients underwent a conduit replacement procedure.
5. Among patients undergoing reoperation, 2 died from endocarditis. The remaining 8 patients are doing well without limitation in physical activity at a mean follow-up period of 32.7*33.9 months (range 2 to 89 months).
6. At 5, 7, and 10 years, the reoperation-free rates among all patients were 96%, 91% and 295 and the survival rates were 82%, 82% and 715.
In conclusion, Rastelli operation is an effective procedure in ameliorating symptoms in a select group of patients with congenital heart disease. Because of the inherent nature of relative graft stenosis and degeneration, a long-term follow-up is
required under the proper selection of the graft material.
(Korean J Thorac Cardiovasc Surg 1995;28:571-8)
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