TGA-VSD and LVOTO: Rastelli Procedure

Abstract

The Rastelli procedure has been, for the last 45 years, the most common technique used for the surgical treatment of transposition of the great arteries (TGA), ventricular septal defect (VSD, and left ventricular outflow tract obstruction (LVOTO). The fundamental parts of the procedure are the baffling of the VSD to the aorta and the reconstruction of the right ventricle outflow tract (RVOT). In spite of low early morbidity and mortality (M/M), substantial late M/M has been reported due to left and right sided obstruction with a late survival of only 48 % at 20 years follow up. Indications of alternative procedures such as Arterial Switch operation with LVOTO resection, the REV procedure and aortic translocation procedure have been described with the aim of improving late survival. In the same way, modifications of the original Rastelli technique have been postulated to diminish such fate. These include improving patient selection by meticulous anatomic diagnosis, early repair and avoidance of long standing palliative systemic to pulmonary shunts, routine enlargement of the VSD by resection of the conal septum, and use of fresh pericardial valved conduits in the pulmonary position. In conclusion, the Rastelli procedure still provides excellent early and late results in selected patients with TGA-VSD and LVOT obstruction.