Réparation à l'Etage Ventriculaire (REV procedure): Not a Rastelli procedure without conduit

Abstract

Since the introduction of the REV procedure in 1980, this operation has become our procedure of choice for patients with transposition of the great arteries, VSD, and POT obstruction. The classical Rastelli procedure is indicated only in patients in whom the presence of a well-functioning pulmonary valve is deemed necessary (i.e., hypoplastic right ventricle, inadequate pulmonary arterial bed). Compared with the Rastelli operation, the REV procedure may have definite advantages: 1 The REV operation creates a straight, short left ventricular-aortic tunnel, provides proper alignment of the aorta with the left ventricular chamber, and practically eliminates the risk of late subaortic stenosis. 2 Complete repair is feasible in patients in whom a Rastelli procedure would be contraindicated because of unfavorable intracardiac anatomy (i.e., restrictive VSD, abnormal attachment of tricuspid chordae on the conal septum). 3 The absence of an extracardiac conduit to restore the right ventricular-pulmonary artery continuity reduces the need for reoperation due to recurrent POT obstruction. In most patients, the long-term outcome of the reconstructed right ventricular outflow tract may be similar to that of a repaired tetralogy of Fallot. However, the need to relieve right ventricular outflow tract obstruction, although reduced in comparison with the Rastelli procedure, is not eliminated completely. 4 Because of its feasibility in most intracardiac situations and because it obviates the need for an extracardiac conduit, the REV procedure can be performed in infants and small children, thus avoiding, in most patients, an initial palliative step.