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Long-Term Results After Senning and Mustard Operations for d-Transposition of the Great Arteries: Atrial Switch
Fabian A Kari1,2,3, Emre Ortac1,2,3, Sebastian G Michel1,2,3
1Department of Pediatric and Congenital Cardiac Surgery, TUM University Hospital German Heart Center, Munich, 80636, Germany.
Insights
The Senning atrial switch procedure offers better long-term survival than the Mustard procedure for d-transposition of the great arteries (d-TGA). This surgical option remains valuable for late-presenting congenital heart conditions.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Atrial switch procedures (Senning and Mustard) were standard for d-transposition of the great arteries (d-TGA).
- These procedures carry long-term risks associated with a systemic right ventricle.
Purpose of the Study:
- To evaluate long-term outcomes of Senning and Mustard atrial switch procedures.
- To compare survival rates and reoperation frequencies between the two surgical techniques.
Main Methods:
- Retrospective follow-up study of 417 patients with d-TGA treated between 1974-2001.
- Analysis focused on survival, baffle-related, and non-baffle-related reoperations.
- Median follow-up duration was 34.2 years.
Main Results:
- Overall 40-year survival was 78.3%.
- Senning procedure showed superior 40-year survival (81.6%) compared to Mustard (66.7%) (p<0.001).
- Freedom from reoperation at 40 years was 73.1%.
Conclusions:
- The Senning procedure demonstrates superior long-term survival compared to the Mustard procedure.
- Senning offers survival rates only slightly inferior to the general population up to the fifth decade.
- The Senning operation should be maintained for late presentations of d-TGA and related conditions.
Objectives:
The Senning and Mustard atrial switch procedures, once the standard surgical treatment for transposition of the great arteries, carry the long-term risks linked to a systemic right ventricle.
Methods:
A retrospective follow-up study was conducted to characterize long-term outcomes focusing on survival, baffle-related, and non-baffle-related reoperations.
Results:
N = 417 patients with d-transposition of the great arteries (d-TGA) (70% male) were treated with an atrial switch operation in one centre (n = 88 Mustard, n = 329 Senning, treated in 1974-2001). The mean follow-up time was 29.7 (SD 14.2) years, with a median follow-up of 34.2 years (range 10-50 years). The average age of the patients at the last follow-up was 30.9 (SD 14.1) years. Overall survival at 40 years was 78.3% (95% CI, 74.0%-82.8%) with n = 128 patients under observation. Forty-year survival was 81.6% (95% CI, 77.0%-86.5%, n = 91 at risk) after Senning and 66.7% (95% CI, 57.2%-77.8%, n = 37 at risk) after Mustard (log-rank P < .001). Freedom from reoperation at 40 years was 73.1% (95% CI, 68.4%-78.0%). After the Senning, long-term survival over 4 decades was slightly inferior to survival of a general population sample.
Conclusions:
Given a survival up to the fifth life decade only slightly inferior to a normal population and superiority of the Senning over the Mustard operation, the Senning should remain in the congenital cardiac surgeons' armamentarium for late presentation of TGA, ccTGA, and other indications.
Clinical Registration Number:
The study is designed as a retrospective study.
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