Long Term Results of Rastelli Operation with a Mechanical Valve

Choi, Se Hoon; Kim, Woong Han; Kim, Kwan Chang; Kwak, Jae Gun; Kim, Chang Young; Lee, Jeong Ryul; Kim, Yong Jin; Rho, Joon Ryang

Abstract

BACKGROUND: Homografts and bioprostheses are most commonly used for Rastelli operation in congenital heart disease, but the limited durability is responsible for multiple reoperations associated with increased morbidity. This study evaluated long-term results after Rastelli operation with a mechanical valved conduit. MATERIAL AND METHOD: A total of 20 patients underwent Rastelli operation with mechanical valved conduit from January 1990 to July 1992. Operative mortality was 1 of 20 patients, and a retrospective review of 19 patients (10 males, 9 females) was done. Initial diagnosis was congenitally corrected transposition of great arteries (cc-TGA, n=4), complete TGA (n=2), ventricular septal defect with pulmonary atresia (VSD with PA, n=9), truncus arteriosus (n=2), double outlet right ventricle with pulmonary stenosis (DORV with PS, n=2). The mean age at Rastelli operation was 4.6+/-3.4 years, and mean follow-up period was 12.8+/-2.7 years. Patients underwent Rastelli opearation using 16 CarboMedics mechanical valve, and 3 Bjork-Shiley mechanical valve (17+/-2 mm). RESULT: There were 15 reoperations for failed mechanical valved conduit. The freedom from reoperation at 5 and 10 years was 53% and 37%. Most patients were received oral anticoagulation with warfarin, and maintained the international normalized ratio (INR) of 1.5 to 2.0. There was no anticoagulation or thromboembolism related complication. There was a significant difference in the causes of a conduit failure between early (within 3 years) and late (after 3 years) failure groups. The six patients reported early prosthetic valve failure, mainly due to valvular dysfunction by thrombosis or pannus formation. The other nine patients reported late prosthetic valve failure, mainly due to dacron conduit stenosis at anastomosis sites, whereas their valvar motion was normal except 1 patient.
CONCLUSION
To avoid early prosthetic valve failure, strict anticoagulation therapy would be helpful. About the late development of obstructive intimal fibrocalcific peels within the Dacron conduit, an improvement of conduit material is necessary to reduce late prosthetic valve failure. In selected patients, the long term results were satisfactory.