Protection of the sinus node in Mustard's operation.

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Cardiac Electrophysiology

Background:

• The Mustard operation is a palliative surgical procedure for Transposition of the Great Arteries (TGA).
• Post-operative dysrhythmias, particularly those affecting the sino-atrial node, are a known complication of the Mustard operation.
• Surgical techniques have evolved to mitigate these risks.

Purpose of the Study:

• To compare the incidence of dysrhythmias following the Mustard operation before and after specific surgical modifications.
• To evaluate the effectiveness of surgical changes aimed at preserving sino-atrial node function.

Main Methods:

• Retrospective analysis of 70 patients operated on before January 1972 and 58 patients operated on after January 1972.
• Comparison of dysrhythmia occurrence based on the timing of the Mustard operation relative to surgical modifications.
• Surgical modifications included altered superior vena cava cannulation, right atrial incision, and baffle patch placement to protect the sino-atrial node.

Main Results:

• A significant decrease in the incidence of dysrhythmias was observed in patients who underwent the modified surgical procedure.
• The modified technique reduced the occurrence of heart rhythm disturbances post-Mustard operation.
• Dysrhythmias were not completely avoided, indicating ongoing challenges.

Conclusions:

• Surgical modifications implemented after January 1972 effectively reduced the incidence of dysrhythmias after the Mustard operation for TGA.
• Preserving the sino-atrial node and its arterial supply through surgical technique changes is crucial for improving outcomes.
• Further refinements may be necessary to completely eliminate post-operative dysrhythmias.