Mustard's operation modified to avoid dysrhythmias and pulmonary and systemic venous obstruction

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Complete transposition of the great arteries (TGA) is a critical congenital heart defect.
• The Mustard operation is a palliative surgical procedure for TGA.
• Previous Mustard operations were associated with significant risks of dysrhythmias and venous obstruction.

Purpose of the Study:

• To evaluate a modified Mustard operation designed to minimize postoperative dysrhythmias and systemic/pulmonary venous obstruction.
• To assess the long-term efficacy and safety of this modified surgical approach for TGA.

Main Methods:

• A modified Mustard operation was performed on 130 patients between May 1973 and May 1978.
• Surgical modifications focused on avoiding the sinus and atrioventricular nodes and optimizing baffle design.
• Postoperative outcomes, including rhythm status and venous obstruction, were assessed via ECG and autopsy findings.

Main Results:

• Of 102 surviving patients, 99 maintained sinus rhythm on standard ECG.
• Fifteen percent of patients undergoing the modified Mustard operation for TGA experienced dysrhythmias on 24-hour ECG monitoring.
• No pulmonary venous or inferior vena caval obstruction occurred; six cases of superior vena caval obstruction were noted.

Conclusions:

• The modified Mustard operation effectively reduces postoperative dysrhythmias and venous obstruction in TGA correction.
• Surgical techniques, including wide septum secundum excision and specific baffle design, are crucial for minimizing complications.
• This modified approach suggests the Mustard operation remains a viable option and should not be prematurely abandoned.