Damus-Rastelli Procedure for Biventricular Repair of Aortic Atresia and Hypoplasia

Background Biventricular repair (BVR) can be achieved in aortic atresia with ventricular septal defect (VSD) by creating a double outlet left ventricle, Damus-Kaye-Stansel procedure and placement of a right ventricular-pulmonary artery conduit. This study is a review of 15 years experience with this “Damus-Rastelli” technique to assess clinical outcomes in comparison with a standard univentricular approach. Methods A review of 16 patients with aortic atresia or complex left ventricular outflow tract obstruction who underwent BVR between 1990 and 2005; a comparison with outcomes for the Norwood I procedure over the same period. Results Early mortality was 19% (3 patients) with no deaths in the last 12 years (13 patients). Twelve patients had associated aortic interruption (56%) or coarctation (19%). Anatomic subtype was not a risk for early death. Late age at operation was the only risk factor identified for early death (p = 0.01). Median follow-up was 32 (range, 4 to 190) months. Actuarial survival at one and five years was 60% and 53%, respectively. This compares with an early mortality of 29% (p < 0.01) and actuarial survival of 58% and 50% in the Norwood group. Freedom from reintervention was 68% and 20% at one and five years, respectively. One patient required balloon dilatation of recurrent coarctation, all others were balloon dilatation (n = 2) or surgical (n = 4) conduit replacement. All survivors are currently in New York Heart Association class I. Conclusions Biventricular repair of aortic atresia and VSD can be achieved with results that compare well with univentricular palliation. Despite the need for conduit change, the long-term benefit of a BVR would support this technique. Delay in performing the initial repair may increase mortality.