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Arrhythmia and mortality after the Mustard procedure: a 30-year single-center experience
M Gelatt1, R M Hamilton, B W McCrindle
1Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
The Mustard operation for great vessel transposition has long-term risks including late death, loss of sinus rhythm, and atrial flutter. Continued follow-up is essential due to ongoing risks after this surgical repair.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiac Arrhythmia Research
Background:
- The Mustard operation corrects cyanosis in transposition of the great vessels with low surgical risk.
- However, long-term complications include right ventricular failure, loss of sinus rhythm, atrial flutter, and death.
Purpose of the Study:
- To assess risk factors for late mortality after the Mustard operation.
- To identify predictors of loss of sinus rhythm and atrial flutter in patients post-Mustard procedure.
Main Methods:
- Retrospective review of 534 children undergoing the Mustard operation since 1962.
- Analysis of demographic, anatomic, electrocardiographic, and physiologic data for predictors of outcomes.
- Survival analysis with a mean follow-up of 11.6 years for 478 early survivors.
Main Results:
- Late mortality occurred in 16.1% of survivors, with sudden death being the most frequent cause.
- Sinus rhythm decreased from 77% at 5 years to 40% at 20 years post-operation.
- Atrial flutter-free survival was 73% at 20 years, with risk factors including perioperative bradyarrhythmia and loss of sinus rhythm.
Conclusions:
- Ongoing loss of sinus rhythm is a significant long-term issue.
- Late increases in the risk of atrial flutter and death highlight the need for continued patient monitoring.
- The study emphasizes the necessity of long-term follow-up for patients after the Mustard operation.
Objectives:
Our purpose was to assess the risk factors for late mortality, loss of sinus rhythm and atrial flutter after the Mustard operation.
Background:
The Mustard operation provides correction of cyanosis with low surgical risk in transposition of the great vessels. However, right ventricular failure, loss of sinus rhythm, atrial flutter and death are frequent long-term complications.
Methods:
Records of 534 children who underwent the Mustard operation at a single center since 1962 were reviewed for demographic, anatomic, electrocardiographic and physiologic predictors and outcomes.
Results:
There were 52 early deaths (9.7%). Survival analysis was undertaken for 478 early survivors with a mean follow-up interval of 11.6 +/- 7.2 years. There were 77 late deaths (16.1%), with sudden death (n = 31) the most frequent cause. Survival estimates were 89% at 5 years and 76% at 20 years of age. Risk factors were an earlier date of operation, operative period arrhythmia and an associated ventricular septal defect. Risk (hazard) of late death declined in the first decade, with further peaks in the second decade. Sinus rhythm was present in 77% at 5 years and 40% at 20 years. Loss of sinus rhythm was associated with previous septectomy, postoperative bradycardia and late atrial flutter. Freedom from atrial flutter was 92% at 5 years and 73% at 20 years of age. Risk factors for atrial flutter were the occurrence of perioperative bradyarrhythmia, reoperation and loss of sinus rhythm during follow-up. Risk of atrial flutter demonstrates a late increase.
Conclusions:
Ongoing loss of sinus rhythm and late peaks in the risk of atrial flutter and death necessitate continued follow-up.