About Rastelli Procedure

The Rastelli operation, named after Dr. Giancarlo Rastelli, is a cardiac surgical procedure designed to address complex heart defects, particularly transposition of the great arteries. This intricate procedure redirects blood flow using conduits to channel it to the correct heart chambers, thereby improving oxygenation. Surgeons create new pathways that allow oxygen-rich blood to reach the body while redirecting oxygen-poor blood to the lungs. The meticulous reconstruction of the heart’s anatomy during the Rastelli procedure aims to optimize circulation, providing a life-changing solution for congenital heart conditions. This innovative technique has revolutionized the treatment of complex cardiac anomalies, significantly enhancing outcomes and quality of life for many patients.

The Rastelli surgery specifically targets congenital heart defects, such as ventriculoarterial discordance, ventricular septal defect (VSD), and pulmonary stenosis. These conditions involve abnormal connections between the heart’s ventricles (the lower chambers) and the great arteries, leading to a mixing of oxygenated and deoxygenated blood.

Success rates for the Rastelli procedure vary based on the specific diagnosis, but it is generally regarded as a low-risk surgery. Many children go on to lead relatively normal lives, although they may need to avoid strenuous competitive sports. It’s important to note that surgically implanted conduits and valves can wear out or develop complications over time, which may require additional surgeries for repair or replacement.

Procedure of the Rastelli Procedure

The Rastelli procedure is a highly complex cardiac surgery utilized to treat specific congenital heart defects, particularly complex cases of transposition of the great arteries, ventricular septal defect, and overriding aorta. This surgical technique involves rerouting blood flow and creating a conduit to redirect oxygenated and deoxygenated blood to their appropriate chambers, aiming to correct structural abnormalities and facilitate normalized blood circulation.

• Anaesthesia and Incision: The procedure is performed under general anesthesia. A midline incision is made in the chest to access the heart and surrounding structures.
• Cardiopulmonary Bypass: The patient is connected to a heart-lung machine, which temporarily takes over the function of the heart and lungs during the surgery. This machine maintains blood circulation and oxygenation while the heart is stopped for the operation.
• VSD Closure: The ventricular septal defect (VSD) is closed using a patch made of synthetic material or the patient’s own tissue. This closure separates the ventricles, preventing the mixing of oxygenated and deoxygenated blood.
• Reconstruction of Outflow Tract: The surgeon creates a pathway for blood flow from the right ventricle to the pulmonary artery by placing a conduit or valve between the right ventricle and the pulmonary artery.
• Reestablishment of Aortic Flow: A connection is formed between the left ventricle and the aorta to redirect oxygenated blood from the left side of the heart to the body’s systemic circulation.
• Closure and Recovery: Once the necessary repairs are complete, the surgeon carefully examines the structures to ensure proper blood flow. The heart is gradually rewarmed, and the heart-lung machine is disconnected. The incision is then closed using sutures or surgical staples, and the patient is transferred to the intensive care unit for monitoring and recovery.
• Follow-up Care: Regular follow-up visits are crucial to assess the patient’s recovery and monitor cardiac function. These appointments typically include imaging studies, such as echocardiograms, to evaluate the repaired structures and ensure optimal blood flow and heart performance.