Cirugía de Rastelli: impacto adverso de la comunicación interventricular no relacionada con los grandes vasos en los resultados quirúrgicos

pp 315-322

Abstract

Background
The Rastelli procedure is complex surgical procedure with marked morbidity and mortality in the medium and long term follow-up. These adverse outcomes seem to be more frequent when the ventricular septal defect (VSD) is anatomically remote or noncommitted to the aorta.

Objective
To evaluate the impact of the anatomical location of the VSD on the outcomes of the Rastelli procedure.

Material and Methods
A total of 47 patients were included with a mean follow-up of 6 years after surgery (15 months-14 years). Patients were divided into two groups: group I (committed VSD, n=29) and group II (remote or noncommitted VSD, n=18).

Results
During the immediate postoperative period, reoperations and arrhythmias were more frequent in group II (p=0.05 and p=0.06, respectively). After a mean follow-up of 3 years (1 day-13 years) following surgery, 22 patients underwent 27 reoperations. A residual VSD was closed in 11 patients at a mean of 1 month, 8 of which were remote VSD (p=0.007). Six patients developed subaortic stenosis requiring surgery at a mean of 5 years. The right ventricle-to-pulmonary artery conduit was re- placed in 12 patients at a mean of 5 years. Immediate postoperative mortality was 6% (3 patients). Global mortality was 17.2% (n=8); 7 patients had noncommitted VSD (p=0.003).

Conclusions
Remote VSD in patients undergoing the Rastelli procedure is associated with: 1) increased mortality, 2) greater incidence of reoperations in the immediate postoperative period, and, 3) a trend towards greater incidence of arrhythmias in the immediate postoperative period.