Comparison of Long-Term Outcomes of Atrial Repair of Simple Transposition With Implications for a Late Arterial Switch Strategy

Abstract

Background-We report the single-institution, long-term results of 358 patients with simple transposition of the great arteries surviving Ͼ30 days after a Mustard (nϭ226, 1965 to 1980) or Senning (nϭ132, 1978 to 1992 procedure. Methods and Results-Outcome measures included late death, reintervention, ECG and ambulatory ECG rhythm, new arrhythmia, and functional status. Average follow-up was 13.4 (range 0.32 to 17.9) years for the Senning group and 11.7 (range 0.04 to 23.9) years for the Mustard group. The Senning group had a better survival rate at 5, 10, and 15 years (95% versus 86%, 94% versus 82%, and 94% versus 77%, respectively). In both groups, the majority of late deaths were sudden, without preceding ventricular dysfunction. Survival and survival free of reintervention were significantly better in the Senning group (relative risk [RR] 0.34, Pϭ0.06 versus RR 0.39, Pϭ0.027). Loss of sinus rhythm was comparable and unrelated to death. After era correction, the incidence of atrial flutter was similar and strongly associated with late death in both groups. Clinical systemic ventricular failure was uncommon, and at last follow-up, 92% of the Senning group and 89% of the Mustard group were in New York Heart Association class I. In a model exploring the implications of elective arterial switch conversion, this would only be beneficial if the hazard late after switch was markedly reduced and/or the hazard after the Senning procedure increased with time. Conclusions-Late outcomes after the Senning procedure are superior to those after the Mustard procedure. Both groups had late sudden deaths that were not associated with clinical systemic ventricular failure. Good functional status after the Senning procedure suggests that a strategy of elective switch conversion cannot be justified for patients with isolated transposition. (Circulation. 1999;100[suppl II]:II-176 -II-181.)

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

“…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].…”

“…Whereas, Sarkar et al [14] observed a significantly better survival of patients after the Senning's operation (94% versus 77% at 15 years), Wells and Blackstone [8] reported the Senning's operation to be a risk factor for late death. In contrast, Oechslin and Jenni [7] reported a similar long-term outcome for the Toronto Mustard group and the Zurich.…”

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

“…Az is igazolást nyert, hogy a pacemakerbeültetés szükségessége össze-függ a mortalitással ezekben a betegekben. A fentieken túl számos egyéb tanulmány vizsgálta a Mustard-és a Senning-műtétek hosszú távú eredményességét [4,[21][22][23][24].…”

ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary

“…The atrial surgery is extensive, and sinus node dysfunction is common. 211,212 Of 478 patients who survived the perioperative period after Mustard repair in a study reported by Gelatt and coworkers, atrial flutter subsequently occurred in 14%, and ectopic AT occurred in 1% (3 patients). The actuarial rate of atrial flutter at 20 years after repair was 24%.…”

“…149,213 For these reasons, development of atrial arrhythmias has been associated with an increased risk of death and sudden death in some, but not all, studies. 212 Acute management of rapid SVT is as discussed above (see Sections IV and V). These arrhythmias tend to be recurrent, and attempts to maintain sinus rhythm are usually warranted due to the hemodynamic compromise produced by the arrhythmia.…”