SEOUL NATIONAL UNIVERSITY HOSPITAL

Proves the superiority of REV operation for complex cardiac malformation

The research team at Seoul National University Hospital (SNUH) has proved for the first time in Korea that REV (réparation à l’étage ventriculaire) operation is more effective in increasing the patient’s long-term survival rate than Rastelli operation, which is known to be the standard operation.

  The team of Professors Hong-Gook Lim and Yong Jin Kim at the cardiothoracic surgery department of SNUH has analyzed the long-term result of 50 pediatric patients (average age of 1.9 years) who received REV operation from SNUH due to complex cardiac malformation. The research took place for 25 years from 1988.

  The result demonstrated that the patients who received REV operation had 87.3% of 25-year survival rate. This far exceeds the 20-year survival rate of the patients who received Rastelli operation, which is between 52% and 59%, as known by the literatures from overseas.

  This research subjects pediatric patients with complex cardiac malformation who have ventriculoarterial discordance that is accompanied by ventricular septal defect and pulmonary stenosis. The heart is composed of 2 ventricles and 2 atriums. The ventricle pumps the blood out of the heart and it is directly connected to artery. The left ventricle uses the aorta to circulate blood in the body and the right ventricle uses the pulmonary artery to send blood to the lungs.

  Ventricular septal defect is a congenital cardiac disease which means that there is a hole on the wall between right and left ventricles through which the blood passes. Pulmonary stenosis means that the channel between the right ventricle and the pulmonary artery becomes narrower, which makes it difficult for the blood flow to move from the heart to the lungs.

Rastelli operation closes the hole between the right and left ventricles, and inserts a valved conduit in the narrow channel between the right ventricle and the pulmonary artery. This enables the blood to flow well from the right ventricle to the pulmonary artery.

  Due to the insertion of valved conduit, Rastelli operation cannot be performed on young pediatric patients, and reoperation of conduit is inevitable as the time passes. Additionally, the long-term satisfaction was low due to the obstruction of left ventricular outflow tract and conduit, and frequent incidence of arrhythmia along with other reasons.  

  REV operation overcomes these shortcomings. This new method excises the infundibular septum to connect the left ventricle and the aorta short and wide, and it utilizes the autologous tissue to reconstruct the right ventricular outflow tract without the valved conduit.

 SNUH was the first in Korea to perform REV operation in 1988 and posted a superb result by creatively changing the REV operation to be more simple and placed on orthotopic position. The 25-year-long achievement of REV operation for complex cardiac malformation is only accomplished by 2 hospitals globally.

  Professor Hong-Gook Lim stated that, “The topic of which operation is more effective for complex cardiac malformation has been the subject of heated debates for some time. This research is expected to provide a selection guideline to thoracic and cardiovascular surgeons”.

  The research achievement was announced in Toronto, Canada during this year’s the 94th American Association for Thoracic Surgery, which is the most prestigious seminar in thoracic surgery. It was awarded with the Grand Prize in Pediatric Cardiac Surgery and was also published in The Journal of Thoracic and Cardiovascular Surgery in September, 2014.