Best Hospitals for Rastelli Procedure in Hyderabad, India

The Rastelli Procedure addresses a triad of congenital cardiac anomalies: dextro-Transposition of the Great Arteries (d-TGA), a large Ventricular Septal Defect (VSD), and significant Left Ventricular Outflow Tract Obstruction (LVOTO) — a combination that is incompatible with long-term survival without surgical correction. In this anatomic configuration, the aorta arises from the right ventricle and the pulmonary artery from the left ventricle; the LVOTO prevents effective arterial switching, making the standard arterial switch operation unsuitable. Without repair, systemic oxygen saturations remain critically low, progressive ventricular dysfunction occurs, and median survival without intervention is measured in months to a few years.

• ELIGIBLE PATIENTS:
• Infants and children (most commonly aged 1–5 years, though timing is individualized) with confirmed d-TGA + large subaortic VSD + fixed or dynamic LVOTO (subpulmonary stenosis, pulmonary valve stenosis, or pulmonary atresia)
• Patients with adequate left ventricular size (LV-to-RV volume ratio assessed on cardiac MRI/CT; LV must be capable of sustaining systemic circulation)
• Patients with sufficient VSD size to allow unobstructed intracardiac tunnel construction (typically ≥50% of the aortic annulus diameter)
• Patients with Truncus Arteriosus Type I/II (as an extension of Rastelli-type repair principles with RV-PA conduit reconstruction)
• +15 more

Standard Rastelli Procedure (OPEN HEART — Cardiopulmonary BYPASS):

Performed via median sternotomy under cardiopulmonary bypass (CPB) with moderate hypothermia (25–28°C) and cardioplegic arrest. The intracardiac tunnel is constructed from autologous pericardium or a Dacron patch, creating a non-obstructive conduit from the left ventricle through the VSD to the native aortic annulus. The LVOTO is resected or bypassed. An extracardiac valved conduit — size selected based on patient BSA and expected somatic growth — is anastomosed between the right ventricular infundibulum and the main pulmonary artery. Conduit choices include: (1) Cryopreserved pulmonary homograft (gold standard for longevity and hemodynamics), (2) Contegra bovine jugular vein conduit (widely available, good intermediate-term results), (3) Carpentier-Edwards or Hancock bioprosthetic valved conduits, and (4) CorMatrix or tissue-engineered conduits (investigational). Intraoperative TEE confirms unobstructed LV-to-Ao tunnel flow, assesses residual VSD, and evaluates conduit gradient before CPB separation.

REY Modification (anatomic Repair WITH Pulmonary Autograft VARIANTS):

In selected centers, modifications such as the Lecompte maneuver (anterior translocation of the pulmonary bifurcation) or integration of autologous tissue reconstruction are employed to reduce conduit length and tension, potentially extending conduit longevity.

PHASE 1 — PRE-OPERATIVE EVALUATION (Days 1–5 after arrival):

• Day 1: GAF Healthcare coordinator receives patient, transfers to hospital; admission workup begins
• Days 1–2: Cardiologist consultation; review of prior records, echocardiograms, and imaging from home country
• Days 2–4: Dedicated pre-operative diagnostics — cardiac catheterization (if not recently performed), cardiac MRI or CT angiography, anesthesia assessment, blood cross-match, nutritional and respiratory optimization
• Day 4–5: Multi-disciplinary team (MDT) case conference; surgical plan finalized; informed consent obtained from parents/guardians; surgical date confirmed

PHASE 2 — Surgery DAY: