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Published on: September 9, 2020
The Senning operation for complete transposition: mid-term physiologic, electrophysiologic, and functional results
W H Merrill1, J R Stewart, J W Hammon
1Department of Cardiac and Thoracic Surgery and the Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
The Senning operation for complete transposition offers low mortality in children. However, long-term outcomes may be affected by arrhythmias and reduced right ventricular function.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiac Electrophysiology
Background:
- Complete transposition of the great arteries is a critical congenital heart defect.
- The Senning operation is a surgical technique for atrial repair of complete transposition.
- Long-term outcomes and potential complications of the Senning operation require ongoing evaluation.
Purpose of the Study:
- To analyze the surgical results and long-term outcomes of the Senning operation in infants and children with complete transposition.
- To assess operative mortality, late mortality, and functional status post-surgery.
- To identify the incidence of arrhythmias and evaluate right ventricular function after the procedure.
Main Methods:
- Retrospective analysis of 110 infants and children undergoing the Senning operation between 1978 and 1990.
- Evaluation of operative and late mortality, patient follow-up duration, and functional classification (New York Heart Association).
- Postoperative cardiac catheterization, electrophysiologic studies, and Holter monitoring were performed in subsets of patients to assess ventricular function and arrhythmias.
Main Results:
- The operative mortality rate was 5.5%, with one late death. Average follow-up was 48.1 months.
- Right ventricular ejection fraction was depressed in a significant portion of patients, particularly under stress.
- Arrhythmias were common, with 26 patients experiencing significant arrhythmias, including 6 requiring pacemakers. Mild tricuspid regurgitation and superior caval vein obstruction were noted in some patients.
Conclusions:
- The Senning operation can be performed with low operative and late mortality for complete transposition.
- While serious baffle complications are rare, long-term functional status may be impacted by arrhythmias and impaired right ventricular function.
- Most surviving patients achieve good functional class, but careful long-term monitoring is essential.
Abstract:
SummaryWe report analysis of surgical results in 110 consecutive infants and children who underwent atrial repair of simple complete transposition using the Senning operation between February 1978 and May 1990. Mean age at operation was 5.4 months ± 6.1 (range 1 week to 4 years); 75 were less than 6 months old. There were 72 males and 38 females. Operative mortality rate was 5.5%, with one late death. Average follow-up is 48.1 months with 44 followed greater than 3 years, and 27 greater than 5 years. Postoperative cardiac catheterization was performed in 48 patients. Right ventricular ejection fraction averaged 0.52 ± 0.08 and was normal in 28 patients. Response of right ventricular ejection fraction to afrerload stress was abnormal in 12 of 14 patients tested. Right ventricular ejection fraction increased normally during exercise in 6 patients, but was abnormal in 15. Mild tricuspid regurgitation was noted in 12 patients. Mild obstruction of the superior caval vein was noted in 4 patients. Baffle leak requiring reoperation occurred in one patient. Fifty-seven of 90 patients are in sinus rhythm by latest electrocardiogram. Postoperative electrophysiologic studies were performed in 34 patients, and Holter monitoring in 25. Significant arrhythmia occurred in 26 patients: 6 patients required pacemakers for slow junctional rhythm or complete heart block; 20 additional patients have a junctional rhythm. Six patients have delayed sinus nodal recovery time. At last follow-up, 88 children (98%) are in New York Heart Association functional Class I, and 2 (2%) are in Class II. The Senning operation for compete transposition can be accomplished with a low operative and late mortality. Serious baffle complications requiring reoperation are rare. Surviving patients are clinically well, but arrhythmias and depressed right ventricular function may limit their long-term functional status.