Twenty-five-year experience with Rastelli repair for transposition of the great arteries

Objective: Our purpose was to describe the outcome of the Rastelli repair i n D-transposition of the great arteries and to determine the risk factors a ssociated with unfavorable events. Methods: From March 1973 to April 1998, 101 patients with D-transposition o f the great arteries and ventricular septal defect underwent a Rastelli typ e of repair. Median age and weight were 3.1 years (10th to 90th percentiles 0.3-9.9 years) and 12.8 kg (5.9-28.2), Pulmonary stenosis was present in 7 3 patients and pulmonary atresia in 18; 10 patients had no left ventricular outflow tract obstruction, Results: There were 7 early deaths: (7%) and no operative deaths in the las t 7 years of the study. Risk factors for early death, by univariable analys is, included straddling tricuspid valve (P =.04) and longer aortic crosscla mping times (P =.04). At a median follow-up of 8.5 years, there: were 17 la te deaths and 1 patient had undergone heart transplantation. Forty-four pat ients had reoperations for conduit stenosis, 11 for left ventricular outflo w tract obstruction, and 28 had interventional catheterization to relieve c onduit stenosis. Nine patients had late arrhythmias, and there were 5 sudde n deaths. Overall freedom from death or transplantation (Kaplan-Meier) was 82%, 80%, 68%, and 52% at 5, 10, 15, and 20 years, respectively. Freedom fr om death or reintervention (catheterization or surgical treatment) was 53%, 24%, and 21% at 5, 10, and 15 years of follow-up, respectively. Conclusions: The Rastelli repair can be performed with low early mortality. However, substantial late morbidity and mortality are associated with cond uit obstruction, left ventricular outflow tract obstruction, and arrhythmia .