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Cardiac rhythm after Mustard repair and after arterial switch operation for complete transposition
H H Kramer1, S Rammos, O Krogmann
1Department of Pediatric Cardiology, Heinrich-Heine-Universität, Düsseldorf, F.R.G.
Insights
The arterial switch operation for complete transposition of the great arteries shows significantly lower arrhythmia prevalence than the Mustard repair. Patients undergoing arterial switch had fewer rhythm disturbances and better long-term outcomes.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Electrophysiology
Background:
- Congenital heart defects like complete transposition of the great arteries (TGA) require surgical correction.
- The arterial switch operation (ASO) and Mustard repair are common surgical techniques for TGA.
- Long-term arrhythmia prevalence after these repairs varies, necessitating comparative studies.
Purpose of the Study:
- To compare the incidence of arrhythmias in patients with TGA after ASO versus Mustard repair.
- To evaluate the long-term rhythm disturbance frequency in different surgical cohorts.
Main Methods:
- Retrospective analysis of 45 patients post-ASO and 47 post-infancy Mustard repair.
- 24-hour Holter ECG monitoring at similar follow-up intervals (approx. 24 months).
- Comparison with an older cohort (pre-1981) of Mustard repair patients studied at a later follow-up (approx. 85 months).
Main Results:
- No symptomatic brady-/tachyarrhythmia syndrome occurred post-ASO; it occurred rarely after infant Mustard repair and more frequently in older Mustard repair patients.
- Sinus node dysfunction was absent post-ASO, but present in both Mustard repair groups.
- Complete atrioventricular block developed in 3 older Mustard repair patients.
- Normal Holter findings were 93% post-ASO, 51% post-infancy Mustard, and 29% post-older Mustard repair.
Conclusions:
- The arterial switch operation is associated with a significantly lower prevalence of arrhythmias compared to the Mustard repair.
- ASO offers superior long-term cardiac rhythm outcomes in patients with TGA.
- Mustard repair, especially when performed at an older age, carries a higher risk of late-onset arrhythmias and conduction disturbances.
Abstract:
We compared the prevalence of arrhythmias among the first consecutive 45 patients with complete transposition (concordant atrioventricular and discordant ventriculo-arterial connexions) after arterial switch operation and the last 47 patients after Mustard repair in infancy. Both groups had 24-hour Holter electrocardiographic studies at similar periods of follow up (24 +/- 14 and 25 +/- 18 months). A second group of patients undergoing the Mustard procedure had been repaired at an older age before 1981. They were studied to determine the frequency of disturbances of rhythm during later postoperative follow-up (85 +/- 24 months). Symptomatic brady-/tachyarrhythmia syndrome never occurred after the arterial switch and only once in the group of patients repaired by the Mustard procedure in infancy, but developed at a late stage (69 +/- 28 months); five times in the group of patients having Mustard's repair at an older age. In addition, Holter monitoring did not detect bradyarrhythmias indicating sinus node dysfunction in a single patient after the arterial switch, but did so to a similar extent in both groups having the Mustard procedure (recent: n = 14; older: n = 18). Three cases of the group of older patients undergoing a Mustard operation developed complete atrioventricular block during follow-up. Normal findings were present in 93% of the cases after arterial switch, but in only 51% of the cases with a similar follow-up repaired by the Mustard procedure, and in 29% of the group having the Mustard repair at an older age.(ABSTRACT TRUNCATED AT 250 WORDS)