The Rastelli procedure is an open heart surgical procedure developed by Italian

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

and cardiac surgery

research Research is "creativity, creative and systematic work undertaken to increase the stock of knowledge". It involves the collection, organization and analysis of evidence to increase understanding of a topic, characterized by a particular att ...

er,

Giancarlo Rastelli Giancarlo Rastelli (1933–1970) was a cardiac surgeon. He was the creator of the Rastelli procedure. He died of cancer at 36 years of age. At the time of his death, he was the head of cardiovascular surgical research at the Mayo Clinic in Roche ...

, in 1967 at the

Mayo Clinic The Mayo Clinic () is a nonprofit American academic medical center focused on integrated health care, education, and research. It employs over 4,500 physicians and scientists, along with another 58,400 administrative and allied health staff, ...

, and involves using a pulmonary or aortic homograft conduit to relieve pulmonary obstruction in double outlet right ventricle with pulmonary stenosis. On July 26, 1968, the first successful surgery was carried out at the Mayo Clinic by Dr. Robert Wallace.

Usage

It is used to correct certain combinations of

congenital A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...

heart defects (CHDs): #

dextro-Transposition of the great arteries dextro-Transposition of the great arteries (d-Transposition of the great arteries, dextro-TGA, or d-TGA) is a potentially life-threatening birth defect in the large arteries of the heart. The primary arteries (the aorta and the pulmonary artery) ...

(d-TGA), ''or''

overriding aorta An overriding aorta is a congenital heart defect where the aorta is positioned directly over a ventricular septal defect (VSD), instead of over the left ventricle. The result is that the aorta receives some blood from the right ventricle, causing ...

, ''or''

double outlet right ventricle Double outlet right ventricle (DORV) is a form of congenital heart disease where both of the great arteries connect (in whole or in part) to the right ventricle (RV). In some cases it is found that this occurs on the left side of the heart rather t ...

(DORV); ''and'' # Ventricular septal defect (VSD); ''and'' # Right ventricular outflow tract obstruction (RVOTO): ::*

pulmonary atresia Pulmonary atresia is a congenital malformation of the pulmonary valve in which the valve orifice fails to develop. The valve is completely closed thereby obstructing the outflow of blood from the heart to the lungs. The pulmonary valve is located o ...

; ''or'' ::* pulmonary

stenosis A stenosis (from Ancient Greek στενός, "narrow") is an abnormal narrowing in a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture). ''Stricture'' ...

; ''or'' ::* subpulmonary stenosis.

Timing

The Rastelli procedure is typically performed between one and two years of age. Since d-TGA, overriding aorta, and DORV are

cyanotic heart defect A cyanotic heart defect is any congenital heart defect (CHD) that occurs due to deoxygenated blood bypassing the lungs and entering the systemic circulation, or a mixture of oxygenated and unoxygenated blood entering the systemic circulation. It is ...

s, the child is palliated with a Blalock-Taussig shunt in the meantime.

Surgical Method

Oxygenated blood is directed from the left ventricle to the aorta using a Gore-Tex patch. The VSD is also sealed with the patch. The pulmonary valve is surgically closed. From the

right ventricle A ventricle is one of two large chambers toward the bottom of the heart that collect and expel blood towards the peripheral beds within the body and lungs. The blood pumped by a ventricle is supplied by an atrium, an adjacent chamber in the upper ...

to the

pulmonary bifurcation The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of th ...

, a synthetic

conduit Conduit may refer to: Engineering systems * Conduit (fluid conveyance), a pipe suitable for carrying either open-channel or pressurized liquids * Electrical conduit, a protective cover, tube or piping system for electric cables * Conduit curre ...

and a valve are constructed, which lets oxygen depleted blood to flow into the lungs for reoxygenation.

Results

In the last seven years of the study, there were seven early deaths (7%) and no surgical fatalities. Univariable analysis revealed that a straddling tricuspid valve (P =.04) and longer aortic crossclamping periods (P =.04) were risk factors for early mortality. There were 17 late deaths and a patient who had undergone heart transplantation after an average follow-up of 8.5 years. 44 patients underwent reoperations for conduit

, 11 for left ventricular outflow tract obstruction, and 28 for interventional catheterization to alleviate conduit stenosis. There were nine patients with late arrhythmias and five patients who experienced sudden deaths. At 5, 10, 15, and 20 years, overall freedom from death or transplantation (Kaplan-Meier) was 82 percent, 80 percent, 68 percent, and 52 percent, respectively. At 5, 10, and 15 years of follow-up, the rates of death or reintervention (catheterization or surgical therapy) were 53 percent, 24 percent, and 21 percent, respectively.

Conclusions

Overall, the Rastelli procedure has a low initial fatality rate. Conduit blockage, left ventricular outflow tract obstruction, and

arrhythmia Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults ...

, on the other hand, are linked to significant late morbidity and mortality. Almost half of the patients who received the Rastelli operation required heart transplantation or died two decades later.

References

* {{Cardiac surgery procedures Cardiac surgery Congenital heart defects