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J Thorac Cardiovasc Surg 2009;138:390-396
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

The effect of ventricular septal defect enlargement on the outcome of Rastelli or Rastelli-type repair

^a Department of Pediatric Cardiac Surgery, Imam Hospital, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
^b Department of Pediatric Cardiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
^c Department of Biostatics, Tarbiat Modares University, Tehran, Iran

Received for publication September 26, 2008; revisions received December 25, 2008; accepted for publication February 16, 2009.

^_* Address for reprints: Reza Shabanian, MD, Children's Medical Center, 62 Gharib St, 14194, Tehran, Iran. (Email: rzshabanian{at}sina.tums.ac.ir).

Objective: Our purpose was to evaluate the effect of ventricular septal defect enlargement on the early and late morbidity and mortality of patients undergoing Rastelli or Rastelli-type operations.

Methods: A total of 49 patients who underwent Rastelli or Rastelli-type operations between 1991 and 2007 were included in a retrospective follow-up study. Patients were divided into 2 groups: group A had ventricular septal defect enlargement, and group B did not have ventricular septal defect enlargement for comparison. Risk factor analysis for early or late death included patient-related and procedure-related variables, with failure, arrhythmia, and atrioventricular block as outcome parameters.

Results: Median age and weight at the time of the operation were 6 years (range, 3 months–22 years) and 17 kg (range, 7–48 kg), respectively. The ventricular septal defect was enlarged in 28 (57%) patients. Ventricular septal defect enlargement showed a significant statistical relation with late ventricular dysfunction, arrhythmia, and residual ventricular septal defect (P = .023, P = .047, and P = .01, respectively, log-rank test). No relation was found between ventricular septal defect enlargement and permanent pacemaker implantation (P = .73, log-rank test). Furthermore, enlargement of the ventricular septal defect did not show any significant effect on the rate of early mortality (P = .69, Cox regression). Kaplan–Meier estimated survival for patients with ventricular septal defect enlargement was 74% at 5 years and 65% at 10 years. Freedom from late death in the group without ventricular septal defect enlargement was 100% at 5 and 10 years and 83% at 15 years. At a median follow-up of 4 years (range, 6 months–16 years), there were 12 late-onset deaths: 11 in group A (n = 28) and 1 in group B (n = 21). Ventricular septal defect enlargement greatly increased the risk of late death (P = .009, Cox regression).

Conclusions: Septal resection in patients undergoing Rastelli or Rastelli-type operations has a substantial effect on late morbidity and is a predictive factor for long-term mortality.