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Cardiac rhythm after the Mustard operation for complete transposition of the great arteries
Insights
The Mustard operation improves survival for congenital transposition of the great arteries. However, long-term survivors experience decreased sinus rhythm and a small risk of sudden death.
Area of Science:
- Cardiology
- Pediatric Surgery
- Congenital Heart Disease
Background:
- The Mustard operation is a surgical procedure to correct complete transposition of the great arteries (TGA).
- It involves creating an intra-arterial baffle to reroute blood flow.
- Long-term outcomes and potential complications require continued investigation.
Purpose of the Study:
- To evaluate the long-term effects of the Mustard operation in patients with TGA.
- To assess survival rates, rhythm status, and risk factors for sudden death post-procedure.
Main Methods:
- A cohort of 372 patients who survived the Mustard operation for at least three months were followed.
- Mean follow-up was 4.5 years (range 0.4-15.9 years).
- Data collected included heart rates, sinus rhythm prevalence, mortality, and cause of death.
Main Results:
- Mean resting heart rates were lower than in age-matched controls.
- Sinus rhythm decreased from 76% at operation to 57% by the eighth postoperative year.
- Cumulative survival was 91% at 11 years and 71% at 15 years; 9 sudden deaths occurred.
Conclusions:
- The Mustard operation facilitates extended survival for TGA patients.
- Survivors show a progressive decline in sinus rhythm over time.
- A small but significant risk of sudden death persists in the long term.
Abstract:
The Mustard operation corrects the effects of congenital transposition of the great arteries by creating an intraarterial baffle to direct pulmonary venous blood to the tricuspid orifice and systemic venous blood to the mitral orifice. To identify the long-term effects of this procedure, we followed 372 patients with complete transposition of the great arteries who survived the Mustard operation for at least three months. The mean follow-up period was 4.5 years (range, 0.4 to 15.9); the mean age at operation was 2.0 years. Mean resting heart rates were consistently lower than those for age-matched normal children. Seventy-six per cent of the patients had sinus rhythm during the year of operation--a figure that decreased to 57 per cent by the end of the eighth postoperative year. Twenty-five patients died during the follow-up period, nine suddenly. Life-table analysis revealed a cumulative survival rate of 91 per cent for 11 years and 71 per cent for 15 years after the operation. No strong risk factor for sudden unexpected death identified. This study demonstrates that extended survival among patients with transposition can be expected after the Mustard operation. However, over time there is a decreasing prevalence of normal sinus rhythm in survivors, as well as a small risk of sudden death.