Rastelli procedure

2025-03-23T22:27:26Z

2A00:23C5:FE1C:3701:E51F:4863:B203:DCAA: bad comma

{{short description|Open heart surgical procedure}}
{{More footnotes needed|date=July 2019}}
{{Infobox medical intervention
| name = Rastelli procedure
| synonym =
| image =
| caption =
| alt =
| pronounce =
| specialty = Cardiology
| synonyms =
| ICD10 =
| ICD9 =
| ICD9unlinked =
| CPT =
| MeshID =
| LOINC =
| other_codes =
| MedlinePlus =
| eMedicine =
}}

The '''Rastelli procedure''' is an [[open heart surgery|open heart]] [[surgical]] procedure developed by [[Italian people|Italian]] [[physician]] and [[human heart|cardiac]] surgery [[research]]er [[Giancarlo Rastelli]], in 1967 at the [[Mayo Clinic]], and involves using a pulmonary or aortic homograft conduit to relieve pulmonary
obstruction in double outlet right ventricle with pulmonary stenosis.<ref>{{Cite journal|last1=Backer|first1=Carl Lewis|last2=Mavroudis|first2=Constantine|date=2003-08-01|title=The Rastelli Operation|url=https://www.optechtcs.com/article/S1522-2942(03)80012-0/abstract|journal=Operative Techniques in Thoracic and Cardiovascular Surgery|language=English|volume=8|issue=3|pages=121–130|doi=10.1053/S1522-2942(03)00034-7|issn=1522-2942|doi-access=free}}</ref>

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]] [[congenital heart defect|heart defects]] ('''CHD'''s):
# [[dextro-Transposition of the great arteries]] ('''d-TGA'''), ''or'' [[overriding aorta]], ''or'' [[double outlet right ventricle]] ('''DORV'''); '''''and'''''
# [[Ventricular septal defect]] ('''VSD'''); '''''and'''''
# [[Right ventricular outflow tract obstruction]] ('''RVOTO'''):<ref>{{Cite web|title=The Rastelli Procedure for Transposition of the Great Arteries|url=https://www.annalsthoracicsurgery.org/article/S0003-4975(09)00636-5/pdf}}</ref>
::* [[pulmonary atresia]]; ''or''
::* [[human lung|pulmonary]] [[stenosis]]; ''or''
::* [[sub-|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]]s, the child is palliated with a [[Blalock–Thomas–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]] to the [[pulmonary bifurcation]], a synthetic [[wikt:conduit|conduit]] and a valve are constructed, which lets oxygen depleted blood to flow into the lungs for reoxygenation.<ref>{{Cite web|last=Tatco|first=Vincent|title=Rastelli procedure {{!}} Radiology Reference Article {{!}} Radiopaedia.org|url=https://radiopaedia.org/articles/rastelli-procedure|access-date=2021-12-16|website=Radiopaedia|language=en-US}}</ref>

== 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 [[stenosis]], 11 for left ventricular outflow tract obstruction and 28 for interventional [[catheter]]ization 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, avoidance of death or transplantation (Kaplan-Meier) was 82 percent, 80 percent, 68 percent and 52 percent, respectively.

At 5, 10 and 15 years of followup, the rates of death or reintervention (catheterization or surgical therapy) were 53 percent, 24 percent and 21 percent, respectively.<ref name=":0">{{Cite journal|last1=Kreutzer|first1=Christian|last2=Vive|first2=Julie De|last3=Oppido|first3=Guido|last4=Kreutzer|first4=Jacqueline|last5=Gauvreau|first5=Kimberlee|last6=Freed|first6=Michael|last7=Mayer|first7=John E.|last8=Jonas|first8=Richard|last9=Nido|first9=Pedro J. del|date=2000-08-01|title=Twenty-five–year experience with Rastelli repair for transposition of the great arteries|url=https://www.jtcvs.org/article/S0022-5223(00)44496-X/abstract|journal=The Journal of Thoracic and Cardiovascular Surgery|language=English|volume=120|issue=2|pages=211–223|doi=10.1067/mtc.2000.108163|pmid=10917934 |issn=0022-5223|doi-access=free}}</ref>

== Conclusions ==
Overall, the Rastelli procedure has a low initial fatality rate.

Conduit blockage, left ventricular outflow tract obstruction and [[arrhythmia]], on the other hand, are linked to significant late morbidity and mortality.<ref name=":0" />

Almost half of the patients who received the Rastelli operation required heart transplantation or died two decades later.

==References==
{{reflist}}
* {{cite journal |last1=Rastelli |first1=G. C. |last2=McGoon |first2=D. C. |last3=Wallace |first3=R. B. |title=Anatomic correction of transposition of the great arteries with ventricular septal defect and subpulmonary stenosis |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |date=October 1969 |volume=58 |issue=4 |pages=545–552 |issn=0022-5223 |pmid=5387997 |doi=10.1016/s0022-5223(19)42568-3|doi-access=free }}

{{Cardiac surgery procedures}}

[[Category:Cardiac surgery]]
[[Category:Congenital heart defects]]

Vero - Wikipedia - User contributions [en]

Rastelli procedure