Clinical Outcomes after Anatomic Repair Including Hemi-Mustard Operation in Patients with Congenitally Corrected Transposition of the Great Arteries

Abstract

Background and ObjectivesThe aims of this study were to determine the early and late outcomes of anatomic repair of congenitally corrected transposition of the great arteries (ccTGA) and to evaluate effectiveness of the hemi-Mustard procedure.Subjects and MethodsWe conducted a retrospective, single-center study of patients who underwent anatomic repair for ccTGA between July 1996 and December 2013. Sixteen patients were included in the study. The median age at the time of the operation was 3.5 years (range: 0.5-29.7), and the median body weight was 13.3 kg (range: 5.8-54). The median follow-up duration was 7.7 years (range: 0.2-17.4).ResultsAtrial switch was achieved using the Mustard procedure in 12 patients (hemi-Mustard procedure in 11) or the Senning procedure in four patients. The ventriculoarterial procedure was performed using the Rastelli procedure in 11 patients and arterial switch in five patients. Six patients underwent tricuspid valvuloplasty. The survival rate was 93.8±6.1%. The rate of freedom from reoperation at 5 years was 92.3±7.4% in the Rastelli group. All patients except one were New York Heart Association class I. All patients except one had mild tricuspid regurgitation.ConclusionAnatomic repair can be performed with a low risk of in-hospital mortality. The hemi-Mustard strategy for selected patients is one solution for reducing early mortality and morbidity, and long-term complications such as venous pathway stenosis or sinus node dysfunction.

Anatomic Repair Including Hemi-Mustard in Congenitally Corrected Transposition of the Great Arteries: What We know and Still Need to Know

“…Shim et al9) reveals favorable early and intermediate-term outcomes of anatomic repair using this modification in selected patients with ccTGA. Of total 16 patients, 11 patients underwent atrial switch combined with a Rastelli-type procedure and 5 with arterial switch and 11 patients had the hemi-Mustard procedure.…”

The paradox of choice in the surgical management of congenitally corrected transposition: what should we do with all of these options supported by little evidence?

“…It was proposed as early as 2004 as a means of addressing the small effective RV size that sometimes results from Rastelli variants of the double switch operation (22). The combined experience of 76 cases performed by three additional centers has suggested that it may be reasonable to perform a one-anda-half ventricular repair in the context of relative surgical inexperience with the Senning procedure, borderline RV function and unfavorable tricuspid valve anatomy (23)(24)(25)(26).…”

Rheumatic “Taussig-Bing Heart”: A Case Report

“…The goal of anatomic correction is the rerouting of the pulmonary venous return to mLV (morphologic LV) and aorta, the systemic venous return to mRV (morphologic RV) and pulmonary artery that achieving a normal anatomical pattern of circulation., i.e., morphologic LV to aorta and morphologic RV to pulmonary artery. procedures to a hemi-Mustard technique can be performed to overcome the high early morbidity and mortality in more complex anatomy patients to decrease the surgical challenge [57].…”