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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 428-436, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
PR Vouhe, D Tamisier, F Leca, R Ouaknine, F Vernant and JY Neveux
During a 10-year period (1980 to 1990), 62 patients underwent complete
repair for transposition of the great arteries, ventricular septal defect,
and pulmonary outflow tract obstruction. Twenty-two patients (35%) (mean
age 8.1 +/- 7.2 years) underwent the Rastelli operation: The ventricular
septal defect was enlarged anteriorly in eight patients, and right
ventricular-pulmonary artery continuity was established with an
extracardiac valved (9/22) or nonvalved (13/22) conduit. Forty patients
(65%) (mean age 3.3 +/- 3.2 years) underwent the Lecompte modifications:
The conal septum was extensively excised when present (30/40), anterior
translocation of the pulmonary bifurcation was performed in 32 patients,
and right ventricular- pulmonary artery continuity was established by
direct anastomosis without a prosthetic conduit. There were seven early
deaths (11%; 70% confidence limits, 7% to 17%): two after the Rastelli
procedure (9%; 70% confidence limits, 3% to 20%) and five after the
Lecompte operation (12.5%; 70% confidence limits, 7% to 20%). Four patients
were lost to follow-up, yielding a 93% complete follow-up (mean follow-up
55 months). There were two late deaths (one in each group). Actuarial
probability of survival (+/- standard error) at 5 years was 83% +/- 9%
after the Rastelli operation and 84% +/- 6% after the Lecompte procedure.
All long-term survivors (except one in the Rastelli group) were in
functional class I. Five patients in the Rastelli group underwent late
reoperation for obstruction of the extracardiac conduit (28%; 70%
confidence limits, 16% to 42%). Three late reoperations (10%; 70%
confidence limits, 4% to 19%) were required after the Lecompte operation
(one for residual ventricular septal defect and two for residual pulmonary
outflow tract obstruction). At most recent examination, residual pulmonary
outflow tract obstruction was present in seven patients of the Rastelli
group (39%; 70% confidence limits, 26% to 53%) and in six patients of the
Lecompte group (19%; 70% confidence limits, 12% to 29%). The combined
likelihood of reoperation for pulmonary outflow tract obstruction and
residual pulmonary outflow tract obstruction was significantly higher in
the Rastelli group (67% versus 26%; p = 0.005). Both procedures provide
satisfactory early and late results. The Lecompte operation allows complete
repair in infancy, is feasible in patients with anatomic contraindications
to the Rastelli operation, and may reduce the need for reoperation and the
prevalence of residual pulmonary outflow tract obstruction.
ARTICLES
Transposition of the great arteries, ventricular septal defect, and pulmonary outflow tract obstruction. Rastelli or Lecompte procedure?
Department of Thoracic and Cardiovascular Surgery, Laennec Hospital, Paris, France.
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