The hemi-Mustard/bidirectional Glenn atrial switch procedure in the double-switch operation for congenitally corrected transposition of the great arteries: Rationale and midterm results

Malhotra, Samir; Reddy, V. Mohan; Qiu, Mary; Pirolli, Timothy J.; Barboza, Laura; Reinhartz, Olaf; Hanley, Frank L.

doi:10.1016/j.jtcvs.2010.08.063

Cited by 80 publications

(50 citation statements)

References 16 publications

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“…The substantial perioperative and late risks of banding and rebanding the pulmonary artery in ccTGA16 are accepted to gain the advantage of ultimately incorporating the LV into the systemic arterial circulation. Alternative surgical approaches to anatomic repair with the goal of addressing defects while establishing the LV as the systemic ventricle are Rastelli procedure with atrial switch, or a hemi-Mustard/bidirectional Glenn with arterial switch 17. A meta-analysis of 11 studies encompassing 124 patients suggested lower perioperative mortality with the Rastelli-type anatomic repair than with the other surgical approaches 18…”

Section: Surgical Optionsmentioning

confidence: 99%

Contemporary management and outcomes in congenitally corrected transposition of the great arteries

Kutty

Danford

Diller³

et al. 2018

Heart

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Congenitally corrected transposition of the great arteries (ccTGA) can occur in isolation, or in combination with other structural cardiac anomalies, most commonly ventricular septal defect, pulmonary stenosis and tricuspid valve disease. Clinical recognition can be challenging, so echocardiography is often the means by which definitive diagnosis is made. The tricuspid valve and right ventricle are on the systemic arterial side of the ccTGA circulation, and are therefore subject to progressive functional deterioration. The natural history of ccTGA is also greatly influenced by the nature and severity of accompanying lesions, some of which require surgical repair. Some management strategies leave the right ventricle as the systemic arterial pump, but carry the risk of worsening heart failure. More complex 'double switch' repairs establish the left ventricle as the systemic pump, and include an atrial baffle to redirect venous return in combination with either arterial switch or Rastelli operation (if a suitable ventricular septal defect permits). Occasionally, the anatomic peculiarities of ccTGA do not allow straightforward biventricular repair, and Fontan palliation is a reasonable option. Regardless of the approach selected, late cardiovascular complications are relatively common, so ongoing outpatient surveillance should be established in an age-appropriate facility with expertise in congenital heart disease care.

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Section: Surgical Optionsmentioning

confidence: 99%

Contemporary management and outcomes in congenitally corrected transposition of the great arteries

Kutty

Danford

Diller³

et al. 2018

Heart

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“…Finally, reduced mRV volume load would delay the timing of the RV-PA conduit change 19)20). Malhotra et al9) reported that only two revisions of the RV-PA conduit were performed among 25 patients who underwent the hemi-Mustard procedure at 11.6 and 12.4 years after the double switch operation during a median follow-up of 4.9 years (range:7 months-16 years). This shows that RV-PA conduit longevity is significantly improved by the hemi-Mustard procedure.…”

Section: Discussionmentioning

confidence: 99%

“…With accumulated experience and modification of procedures, the outcome of anatomic repair has improved 5)6)7)8). We have modified the Mustard procedure by adding a bidirectional cavopulmonary shunt (BCPS) in the atrial switch procedure (hemi-Mustard procedure) of anatomic repair in selected patients, as reported previously 9)10)…”

Section: Introductionmentioning

confidence: 96%

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

et al. 2017

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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.

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“…This strategy, which technically simplifi es the atrial switch operation, may decrease the risk of sinus arrhythmias and prolong conduit survival due to decreased fl ow secondary to the BDG [ 16 ]. The main drawbacks are the long-term moderate elevation of the SVC pressure, the need for a competent pulmonary valve, the inability to use transvenous access for pacing, and the impaired functional capacity of patients [ 15 ].…”

Section: Issues Related To the 1½ Mustard Proceduresmentioning

confidence: 99%

Anatomic Correction of Corrected Transposition of the Great Arteries with Ventricular Septal Defect and Obstruction of the Left Ventricular Outflow Tract

Hraška

Muríň

2016

Surgery of Conotruncal Anomalies

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The long-term outcome of patients with corrected transposition of the great arteries and associated lesions after physiologic repair is uncertain. Anatomic correction, utilizing the morphologic left ventricle as a systemic pumping chamber and the mitral valve as the systemic atrio-ventricular valve, is considered the preferred method, especially for patients with either tricuspid valve regurgitation, with Ebstein's malformation of the tricuspid valve, or with right ventricle dysfunction. Anatomic correction of corrected transposition of the great arteries with ventricular septal defect and left ventricular outfl ow tract obstruction represents a group of procedures in which the atrio-ventricular discordance is 'corrected' by an atrial switch, and ventriculo-arterial discordance is 'corrected' by the Rastelli procedure, by translocation of the aortic root, or by an arterial switch operation, depending on the underlying morphology and mechanism of the left ventricular outfl ow tract obstruction and/or morphology and position of the ventricular septal defect. These operations can be performed with minimal mortality and acceptable morbidity. In the mid-term, an excellent functional outcome can be achieved, which leads to normal ventricular function, with low incidence of complete heart block. However, the long-term functioning of the conduction system, the aortic valve, the intraventricular tunnel, the conduit, and the ventricles is variable and requires close surveillance. Prophylactic anatomic correction in patients without symptoms and a wellfunctioning tricuspid valve and right ventricle is not recommended.

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The hemi-Mustard/bidirectional Glenn atrial switch procedure in the double-switch operation for congenitally corrected transposition of the great arteries: Rationale and midterm results

Cited by 80 publications

References 16 publications

Contemporary management and outcomes in congenitally corrected transposition of the great arteries

Contemporary management and outcomes in congenitally corrected transposition of the great arteries

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

Anatomic Correction of Corrected Transposition of the Great Arteries with Ventricular Septal Defect and Obstruction of the Left Ventricular Outflow Tract

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