Results with the Mustard Operation in Simple Transposition of the Great Arteries

Abstract

From May 1963 to December 1985, 329 infants and children underwent repair of simple transposition of the great arteries (TGA) using Mustard's technique. To assess improvement, the patients were separated into two groups by date of operation: Group I, May 1963 to December 1973 (N = 106), and Group II, January 1974 to December 1985 (N = 223). The operative mortality was 11 (10.4%) in Group I and two (0.9%) in Group II. The 10-year actuarial survival rate was 73.4% in Group I and 93.7% in Group II. Baffle complications, similar in both groups, were identified in 81 patients; 19 were major, causing death or requiring reoperation. By latest electrocardiogram, 21 of 45 (46.7%) of Group I patients and 129 of 180 (71.7%) of Group II patients were in normal sinus rhythm. Late ambulatory electrocardiography, however, revealed that a majority of patients had sinus node dysfunction or other dysrhythmias. Right ventricular (RV) angiography revealed definite diminution of RV contractility in 14 (11%) of 126 children. At late follow-up, 113 of 148 (76%) children were in New York Heart Association (NYHA) Class I and 35 of 148 (24%) were in NYHA Class II. Thirty-five (21%) patients were on cardiac medication chiefly for dysrhythmia management. There has been significant improvement in the early and late mortality with the Mustard operation, and serious baffle complications are infrequent. Dysrhythmias continue to be a major problem but the surviving patients are clinically well and relatively few have significant RV dysfunction.

Long-term follow-up of arterial switch operation with an emphasis on function and dimensions of left ventricle and aorta☆

“…One patient with Taussig-Bing anomaly developed monomorphic VT late after ASO and received prophylactic ICD. In the present study, no patients developed atrial tachycardia, which is in contrast to the reported high incidence of scar-related atrial tachycardia long-term after the atrial switch procedure [7]. Two patients with simple TGA underwent slow pathway ablation for typical atrioventricular nodal reentrant tachycardia, which has no relationship with the ASO.…”

“…It offers an anatomical correction of the anomaly, in contrary to the earlier performed Senning and Mustard procedures. These procedures have well-known complications such as right ventricular failure, tricuspid regurgitation and arrhythmias [6,7]. The results of early-and mid-term follow-up in ASO are good, with low re-intervention rates [8,9,10].…”

Long‐term outcome after senning operation for transposition of the great arteries

“…18 In our series the incidence of late sudden death was 2.9%, which is in agreement with the range of 2-8% reported in the literature. 5,6,[10][11][12][13][14][15][16] …”

Dyssynchrony and electromechanical delay are associated with focal fibrosis in the systemic right ventricle — Insights from echocardiography

“…Patients are at increasing risk of late ventricular dysfunction and sudden cardiac death. [2][3][4][5][6][7][8][9][10][11] The exact underlying pathophysiological mechanism is likely to be multifactorial. Myocardial ischaemia in the morphologically right systemic ventricle has been suggested based on the presence of perfusion defects, 9 wall motion abnormalities and features suggestive of fibrosis on late gadolinium cardiovascular magnetic resonance (CMR).…”