Long-term Results of Intraventricular Repair of Transposition of the Great Arteries with Left Ventricular Outflow Tract Obstruction: Comparison of Rastelli Operation and REV Operation

Objectives: The purpose of this study is to evaluate the long-term results of transposition of the great arteries (TGA) with left ventricular obstruction and compare between Rastelli operation and REV operation.

Methods: Retrospective study was conducted on 71 patients with TGA with LVOTO who underwent intraventricular rerouting between 1980 and 2014. Total cohort was divided into two groups: Rastelli group (n = 47) and REV group (n = 24). The early and long-term results were compared between two groups.

Results:

Median age was 5.4 years in Rastelli group and 3.8 years in REV group. Mean body weight was 19.1±8.7 kg in Rastelli group and 15.1±6.9 kg in REV group. Mean pressure gradient in left ventricular outflow tract was 59.1±19.9 mmHg in Rastelli group and 48.1±15.0 mmHg. LVOTO included subvalvular stenosis in 7 cases (Rastelli: 3, REV: 4), valvular stenosis in 30 (Rastelli: 21, REV: 9), both subvalvular and valvular stenosis in 19 (Rastelli: 10, REV: 9) and pulmonary atresia in 15 (Rastelli: 12, REV: 3).

Mean aortic cross-clamp time was 91.8±36.1 minutes in Rastelli group, and 94.4 minutes in REV group.

Early mortality was 6.4% in Rastelli group and 8.8 % in REV group. Mean follow-up period was 15.2± 9.9 years. The overall survival at 20 years was 74.7±6.6% in Rastelli group and 74.7±6.6 % in REV group (Long-rank test, p= 0.052). Freedom from reoperation at 20 years was 30.1±8.9 % in Rastelli group and 72.5±13.3% in REV group (Long-rank test, p= 0.0007).

Conclusion: The long-term results of intraventricular rerouting for TGA with LVOTO was favorable in terms of survival. There were no significant differences between groups except for the rate of reoperation.