Abstract 11125: Is the Rastelli Procedure Falsely Maligned?
Background: Surgical options for transposition left ventricular outflow tract obstruction (TGA/LVOTO) are multiple. We and others have noted the Rastelli has high late mortality/morbidity for TGA/VSD/LVOTO. This led to a change in strategy in 2000.
Objective: We hypothesized that patients undergoing a Nikaidoh would have superior outcomes to the Rastelli procedure.
Methods: From ’82-‘13, 157 patients with TGA/LVOTO were operated. Of which 133 (84.7%) had associated VSD. Procedures were: Rastelli (n=41), Mustard ± LVOTO relief (n=41), ASO ± LVOTO relief (n=36), single V (n=26), REV (n=7), and Nikaidoh (n=6). Stratification by era was performed: era 1, ‘82-‘89 (n=70); era 2, ‘90-‘99 (n=50); era 3 ‘00-‘13 (n=37).
Results: Survival at 10 years was not different by strategy: Rastelli 77.9%, Mustard 82.3%, ASO 85.5%, single V 96.2%, REV 100%, and Nikaidoh 83.3% , P=0.24. Survival after the Rastelli improved over eras (at 9 years: era 1=45%, era 2=93%, and era 3=100%, P=0.01) (fig 1A). At 23 years, it was 45% for era 1 and 93% for era 2. Late mortality was independently associated with arrhythmia (OR 3.50; 95% CI 1.15-10.67, P=0.03) but not LVOT gradient (OR 0.95; 95% CI 0.89-1.01, P=0.13) though the first era had a positive time relationship (P=0.01) to increasing gradient (slope 0.49, SE=0.19, 95% CI 0.11-0.88) (LVOT reop fig 1B). The Rastelli and REV were independently associated with all reoperation (OR 10.58; 95% CI 4.23-26.46, P<0.001) and (OR 8.33; 95% CI 1.60-43.17, P=0.01) respectively. The Nikaidoh, Rastelli, and REV had similar RVOT reoperation.
Conclusion: The Rastelli since 1990, had a different outcome than a generation ago potentially suggesting a difference in starting physiologic substrate and or the operation. Greater sample size and follow up will be required to determine if long term outcome differs between the modern Rastelli and Nikaidoh. Given the significant improvement in survival over eras, the current Rastelli remains a viable strategy and is not inferior.
Author Disclosures: M. Al-Jughiman: None. M. Al-Omair: None. O. Honjo: None. E. Oechslin: None. C. Caldarone: None. G. Van Arsdell: None.
- © 2014 by American Heart Association, Inc.