Long-term results of the REV (réparation à l’ètage ventriculaire) operation

Abstract

Despite its innovative features, the réparation à l'ètage ventriculaire (REV) procedure has not gained large popularity in the treatment of transposition of the great arteries, ventricular septal defect, pulmonary stenosis, and related anomalies, and thus the Rastelli operation remains the preferred type of repair. We try to obviate the alleged lack of long-term results that has been suggested to explain this reluctance to change. We reviewed a series of 205 patients who underwent the REV procedure between 1980 and 2003. Hospital mortality was 12% (24 patients). Ten of 181 early survivors residing in distant countries could not be traced for follow-up. There were 13 late deaths (2 of noncardiac causes). Overall survival and freedom from any reoperation at 25 years were 85% and 45%, respectively, as determined by using the Kaplan-Meier method. Reoperation was commonly required because of recurrent right ventricular outflow tract obstruction (36patients) and rarely by left ventricular outflow tract stenosis (3 patients). By using cumulative method analysis, at the 25-year follow-up interval, the probability of being alive without reoperation was 45%, that of reoperation for right ventricular outflow tract obstruction was 33%, and that of reoperation for left ventricular outflow tract obstruction was 5%. Clinical status is excellent: 137 patients are in New York Heart Association class I (87%), and 131 patients are free of arrhythmias. These results represent a considerable improvement over those of the Rastelli operation in terms of survival and need for reoperation for right or left ventricular outflow tract obstruction.