Presence of a Ventricular Septal Defect and the Mustard Operation Are Risk Factors for Late Mortality After the Atrial Switch Operation

Abstract

Background-Survival and functional status of patients with transposition of the great arteries treated by atrial switch are reported to be reasonably good within the first 15 postoperative years. However, in some patients, the function of the systemic right ventricle deteriorates, leading to significant morbidity or even to late mortality. This study seeks to identify risk factors for late death. Methods and Results-Records of 329 patients after the Senning operation and 88 after the Mustard operation at a single center were retrospectively reviewed for demographic, anatomic, and echocardiographic predictors and outcomes. Mean follow-up interval was 19.1Ϯ6.5 years and was 95% complete. Survival 25 years after the Mustard procedure was 75.9Ϯ4.8% and after the Senning procedure was 90.9Ϯ2.3% (Pϭ0.002). Mustard patients died more often of arrhythmia than Senning patients (PϽ0.001) and needed more baffle-related reoperations (PϽ0.0001). Ventricular septal defect closure at the time of the atrial switch operation (hazard rateϭ2.3; 95% confidence interval, 1.1 to 4.7; Pϭ0.025) and the Mustard operation (hazard rateϭ2.0; 95% confidence interval, 1.01 to 3.8; Pϭ0.045) emerged as independent risk factors for late mortality in multivariate analysis. At follow-up, 85.8% of the patients led a normal life with full-time work, and 11.8% were able to do part-time work. Only 2.4% experienced noticeable limitation of activities. Conclusions-Our patient data reveal satisfactory results at long term in this historic collective. Patients who had undergone ventricular septal defect closure at the time of the atrial switch operation and those who had undergone a Mustard operation are at higher risk for late death. Close follow-up, especially of these subgroups, is warranted.

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

“…Loss of sinus rhythm at long term has been described in patients after atrial baffle procedures [7,8,12,13], with the incidence being the same after the Senning or the Mustard procedure [10]. However, Lange et al [14] present in their series, sinus rhythm in 80.8% of the patients, 17.4 years after the Senning's procedure, which is higher than in other reported series [13,14].…”

“…Lange et al [12] had 90.9% ± 2.3% of surviving patients in 25 years of follow-up, after the Senning procedure and 75.9% ± 4.8%, after the Mustard procedure and thus, it was significantly different in invariable analysis. The Mustard procedure remained a significant risk factor for late death in multivariate analysis fully adjusted for all variables that were statistically significant between the 2 groups.…”

Intervenções percutâneas no pós-operatório tardio de cirurgia de correção atrial para transposição das grandes artérias

“…As oclusões dos túneis intra-atriais, sistêmico ou pulmonar, são complicações potencialmente graves, sendo responsáveis por 30,7% das reoperações, como publicado por Lange et al 6 , recentemente. O mecanismo principal da obstrução decorre da retração cicatricial das linhas de sutura.…”

“…As complicações tardias mais freqüentes das cirurgias de Senning ou Mustard incluem obstruções dos túneis intra-atriais (sistêmicos ou pulmonares), disfunção ventricular direita, insuficiência das valvas atrioventriculares, obstrução da via de saída do ventrículo esquerdo, arritmias e até, em alguns casos, morte súbita 5,6 .…”

“…A estenose dos túneis intra-atriais é uma complicação não infreqüente 7 , sendo a principal causa de reoperação, porém com altos índices de morbidade e mortalidade 5,6 .…”