Long term outcome up to 30 years after the Mustard or Senning operation: a nationwide multicentre study in Belgium

Abstract

Objective: To assess long term outcome of patients who underwent Mustard or Senning repair for transposition of the great arteries up to 30 years earlier.Design: Retrospective review of medical records.Setting: The six university hospitals in Belgium with paediatric cardiology departments.Patients: 339 patients were reviewed, of whom 124 underwent the Mustard procedure and 215 the Senning procedure. This represents almost the entire population of patients in Belgium with either simple or complex transposition.Main outcome measures: Mortality, morbidity, functional abilities, social integration.Results: Overall mortality was 24.2%. Early mortality (⩽ 30 days after surgery) accounted for 16.5%, late mortality for 7.7%. Actuarial survival of early survivors at 10, 20, and 30 years after surgery was 91.7%, 88.6%, and 79.3%, respectively. Patients in the Senning cohort had a slightly better survival rate than those in the Mustard cohort (NS). Baffle obstruction occurred more often after Mustard repair (15.3%) than after the Senning procedure (1.4%). Arrhythmia-free survival did not differ between the two cohorts, but was determined by the complexity of the transposition. Survivors of the Senning cohort had better functional status, and tended to engage in more sports activities.Conclusions: The long term outcome for patients surviving the Mustard or Senning operation was favourable in terms of late mortality, morbidity, functional, and social status. Overall mortality in the Senning cohort did not differ from the Mustard group, but Senning patients had better functional status, greater participation in sports activities, and fewer baffle related problems.

In adults with atrial switch operation for transposition of the great arteries low physical activity relates to reduced exercise capacity and decreased perceived physical functioning

“…during exercise, a further increase in heart rate enables a further increase in cardiac output. However, our results, in concordance with other studies, show that d-TGA patients present with chronotropic incompetence 2,3,5,8 .…”

“…Nowadays, these atrial switch techniques are replaced by the arterial switch operation. However, 75% to 80% of the d-TGA patients have survived into adulthood and are still visiting the outpatient clinics for grown-up congenital heart disease 1,2 .…”

Senning operation for correction of the transposition of the great arteries, results, long-term outcome and quality of life

“…Survival functional status and quality of life of patients with transposition of the great arteries (TGA), after an atrial switch operation (Senning or Mustard procedure) are reported to be reasonably good after 2 decades of life [1][2][3][4][5][6][7][8]. However, in many cases, It's possible to detect the function of the systemic right ventricle deteriorates, severe tricuspid regurgitation develops or the patients suffer from arrhythmias.…”

A teljes nagyér-transzpozíción átesett betegek Senning- és Mustard-féle műtéti megoldásának hosszú távú utánkövetése. Eredmények a CSONGRAD Regiszterből

“…Egy nemzeti belga tanulmányban a sajátunkhoz hasonló vizsgálatot mutattak be [19]. Ebben a közlemény-ben hat centrum eredményeit elemezték centrumonként hasonló betegszámmal.…”

“…A nevezett vizsgálatban a két műtéti technika időben egyszerre került alkalmazásra szemben azzal, hogy egyetemünkön először csak Mustard-, majd csak Senning-műtéteket alkalmaztak. Hasonlóan eredményeinkhez, a két módszer mortalitási adatai nem különböztek, azonban a Senning-műtött betegek kedvezőbb funkcionális stádiumban voltak, nagyobb arányú volt a sportaktivitásuk és kevesebb volt a terelő-folttal kapcsolatos problémák aránya [19].…”