Risk factors for late mortality and reoperations following the Rastelli repair for transposition of the great arteries

Objective: This study was undertaken to determine potential risk factors for late mortality and reoperations after the Rastelli operation for correction of transposition of the great arteries.

Patients and methods: Records of 39 patients who underwent the Rastelli operation between 1977 and 2004 were retrospectively reviewed. Median age at the time of operation was 5.1 years (2.2 years within the last 5 years).

Results: There were no early deaths. At a median follow-up of 8.9 years (0 to 25 years), there were 2 sudden deaths, 1 death from pneumonia, 1 death during reoperation, and 2 cardiac transplantations. Freedom from death or transplantation was 93.8±4.3%, and 57.5±15.1% at 10, and 20 years, respectively. Freedom from conduit reoperation was 48.8±10.3%, and 32.5±10.3% at 10, and 20 years, respectively. There was a trend towards an increased risk for death or transplantation in patients ≥4 years of age (n=22, p=0.068) at the time of the Rastelli operation, and in patients who presented with a hemoglobin level >18.5g/dl (n=19, p=0.094). Significantly more conduit reoperations were performed in patients <4 years of age (n=17, p=0.038) at the time of the Rastelli operation.

Conclusions: The Rastelli operation is a low-risk procedure with regard to early mortality. Patients who were ≥4 years of age at the time of the Rastelli operation require less reoperations for conduit exchange. Nevertheless, early Rastelli repair is warranted, since patients ≥4 years at the time of the Rastelli operation may be at risk for a higher mortality in the long-term.