Abstract
Objective—To examine long term morbidity and mortality following atrial inflow corrective procedures for transposition of the great arteries (TGA) and to investigate factors that influence morbidity and mortality. Design—Retrospective cohort study from a single centre. Setting—Cardiology and cardiothoracic surgical unit in a large tertiary referral centre. Patients—All 130 patients who had TGA diagnosed between August 1972 and May 1988 and were considered suitable for atrial inflow correction; 109 of these underwent surgery (operative cohort: 84 Mustard operations and 25 Senning operations); 95 survived to hospital discharge (hospital surviving cohort). Main outcome measures—Death and cardiac events. Results—There were relatively good long term results from atrial inflow correction for TGA with 5, 10, and 15 year survivals of 77.3%, 75.9%, and 71.3%. However, there was an appreciable incidence of late cardiac death and events, with 5, 10, and 15 year cardiac event-free survivals of 74.5%, 67.1%, and 39.6%. Supraventricular tachycardia was the only significant risk factor for late cardiac death (relative risk 8.72, 95% confidence interval, 2.86 to 26.64). Senning patients had better event-free survival (p = 0.04). Conclusions—Atrial inflow correction for TGA has a reasonably good 15 year survival (71.3%), but there is an appreciable incidence of late cardiac deaths and events (15 year event-free survival 39.6%). The Senning procedure is preferable to the Mustard procedure for cases unsuitable for arterial switching. Keywords: transposition of the great arteries; congenital heart disease; Mustard operation; Senning operation
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Figure 1 .
Kaplan-Meier survival curve of operative cohort (n = 109).
Figure 2 .
Event-free survival: comparison of Mustard and Senning cohorts (after adjustment for date of operation).
Figure 3 .
Kaplan-Meier curve of long term survival in sinus rhythm (hospital surviving cohort, n = 95).
Selected References
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- Ashraf M. H., Cotroneo J., DiMarco D., Subramanian S. Fate of long-term survivors of Mustard procedure (inflow repair) for simple and complex transposition of the great arteries. Ann Thorac Surg. 1986 Oct;42(4):385–389. doi: 10.1016/s0003-4975(10)60541-3. [DOI] [PubMed] [Google Scholar]
- Clarkson P. M., Barratt-Boyes B. G., Neutze J. M., Lowe J. B. Results over a ten-year period of palliation followed by corrective surgery for complete transposition of the great arteries. Circulation. 1972 Jun;45(6):1251–1258. doi: 10.1161/01.cir.45.6.1251. [DOI] [PubMed] [Google Scholar]
- Darvell F. J., Rossi I. R., Rossi M. B., Fayers P., Anderson R. H., Rigby M. L., Shinebourne E. A., Lincoln C. Intermediate to late term results of Mustard's procedure for complete transposition of the great arteries with an intact ventricular septum. Br Heart J. 1988 Apr;59(4):468–473. doi: 10.1136/hrt.59.4.468. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Deanfield J., Camm J., Macartney F., Cartwright T., Douglas J., Drew J., de Leval M., Stark J. Arrhythmia and late mortality after Mustard and Senning operation for transposition of the great arteries. An eight-year prospective study. J Thorac Cardiovasc Surg. 1988 Oct;96(4):569–576. [PubMed] [Google Scholar]
- Flinn C. J., Wolff G. S., Dick M., 2nd, Campbell R. M., Borkat G., Casta A., Hordof A., Hougen T. J., Kavey R. E., Kugler J. Cardiac rhythm after the Mustard operation for complete transposition of the great arteries. N Engl J Med. 1984 Jun 21;310(25):1635–1638. doi: 10.1056/NEJM198406213102504. [DOI] [PubMed] [Google Scholar]
- Helbing W. A., Hansen B., Ottenkamp J., Rohmer J., Chin J. G., Brom A. G., Quaegebeur J. M. Long-term results of atrial correction for transposition of the great arteries. Comparison of Mustard and Senning operations. J Thorac Cardiovasc Surg. 1994 Aug;108(2):363–372. [PubMed] [Google Scholar]
- MUSTARD W. T. SUCCESSFUL TWO-STAGE CORRECTION OF TRANSPOSITION OF THE GREAT VESSELS. Surgery. 1964 Mar;55:469–472. [PubMed] [Google Scholar]
- Mok Q., Darvell F., Mattos S., Smith T., Fayers P., Rigby M. L., Shinebourne E. A. Survival after balloon atrial septostomy for complete transposition of great arteries. Arch Dis Child. 1987 Jun;62(6):549–553. doi: 10.1136/adc.62.6.549. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Myridakis D. J., Ehlers K. H., Engle M. A. Late follow-up after venous switch operation (Mustard procedure) for simple and complex transposition of the great arteries. Am J Cardiol. 1994 Nov 15;74(10):1030–1036. doi: 10.1016/0002-9149(94)90854-0. [DOI] [PubMed] [Google Scholar]
- Norwood W. I., Dobell A. R., Freed M. D., Kirklin J. W., Blackstone E. H. Intermediate results of the arterial switch repair. A 20-institution study. J Thorac Cardiovasc Surg. 1988 Dec;96(6):854–863. [PubMed] [Google Scholar]
- SENNING A. Surgical correction of transposition of the great vessels. Surgery. 1959 Jun;45(6):966–980. [PubMed] [Google Scholar]
- Trusler G. A., Williams W. G., Duncan K. F., Hesslein P. S., Benson L. N., Freedom R. M., Izukawa T., Olley P. M. Results with the Mustard operation in simple transposition of the great arteries 1963-1985. Ann Surg. 1987 Sep;206(3):251–260. doi: 10.1097/00000658-198709000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Turina M., Siebenmann R., Nussbaumer P., Senning A. Long-term outlook after atrial correction of transposition of great arteries. J Thorac Cardiovasc Surg. 1988 May;95(5):828–835. [PubMed] [Google Scholar]



