Late outcome of Senning and Mustard procedures for correction of transposition of the great arteries

• Published in: Heart (British Cardiac Society) Vol. 91; no. 5; pp. 652 - 656
• Main Authors: Dos, L, Teruel, L, Ferreira, I J, Rodriguez-Larrea, J, Miro, L, Girona, J, Albert, D C, Gonçalves, A, Murtra, M, Casaldaliga, J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01-05-2005; BMJ; BMJ Publishing Group LTD; Copyright 2005 by Heart
• Subjects: Adolescent; Adult; Arrhythmias, Cardiac - etiology; atrial switch; Biological and medical sciences; Cardiac arrhythmia; Cardiac Surgical Procedures - mortality; Cardiology. Vascular system; Child; Child, Preschool; Congenital diseases; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Death, Sudden, Cardiac - etiology; Echocardiography - methods; Female; Heart; Heart attacks; Humans; Infant; Interventional Cardiology and Surgery; Male; Medical sciences; Mortality; Multivariate Analysis; Mustard; physiological switch; Quality of Life; Reoperation - statistics & numerical data; Retrospective Studies; Senning; Transposition of Great Vessels - diagnostic imaging; Transposition of Great Vessels - mortality; Transposition of Great Vessels - surgery; transposition of the great arteries; Vascular disease; Late; Prognosis; Heart disease; Cardiovascular disease; Evolution; Procedure; Transposition of the great vessels; Congenital disease; Corrections
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2003.029769

Objectives: To evaluate late mortality and morbidity after an atrial switch procedure for correction of transposition of the great arteries (TGA) and to assess predictive factors for adverse outcome. Setting: Tertiary referral centre. Design and patients: Retrospective follow up study of 137 patients surviving hospitalisation for TGA atrial switch procedure (Mustard or Senning) in a single institution and divided into two groups (simple and complex) depending on presurgical anatomy. Several surgical and follow up factors were evaluated during 16.7 (5.6) years’ follow up. Results: Late mortality was 5.1% (95% confidence interval 1.37% to 8.84%) with sudden death as the most common cause. No significant difference was found between Mustard and Senning procedures and between the complex and simple groups in terms of mortality. Independent predictive factors for late mortality were a history of supraventricular tachyarrhythmias and advanced New York Heart Association (NYHA) functional class during follow up. A very common finding was development of sinus node dysfunction (47.6%), which had no influence on mortality. There was little need for reintervention (5.1%) and relatively few cases of right ventricular systolic dysfunction (14.6%). During follow up, most patients (96.2%) were in NYHA functional class I–II. Conclusions: Overall long term outcomes of patients with atrial repair of TGA in the present era are encouraging in terms of late mortality and quality of life. Nevertheless, better outcomes may be offered through improved diagnostic methods for right ventricular function and better management of supraventricular tachyarrhythmias.