Transposition of the great arteries with intact ventricular septum: Results of mustard and senning operations in 123 consecutive patients

• Published in: Journal of the American College of Cardiology 1983-02, Vol.1 (2), p.476-483
• Main Authors: Marx, Gerald R., Hougen, Thomas J., Norwood, William I., Fyler, Donald C., Castaneda, Aldo R., Nadas, Alexander S.
• Format: Article
• Language: English
• Subjects: Child, Preschool; Female; Heart Septum - pathology; Heart Ventricles; Hemodynamics; Humans; Infant; Infant, Newborn; Male; Methods; Mortality; Postoperative Complications; Reoperation; Transposition of Great Vessels - pathology; Transposition of Great Vessels - physiopathology; Transposition of Great Vessels - surgery
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(83)80076-X

The results of Mustard and Senning operations were reviewed in 123 consecutive patients operated on for d-transposition of the great arteries with intact ventricular septum. From 1972 to 1978, 66 patients had a Mustard operation at a mean age at operation of 15.5 months. The mean duration of the follow-up period was 43.5 months; 82% had a postoperative cardiac catheterization. From 1978 to 1980, 57 patients underwent a Senning operation at a mean age at operation of 6.6 months; the mean follow-up period was 13.6 months, and 75% had a postoperative catheterization. Within 30 days of operation, seven (11%) patients in the Mustard group died, and five (8%) died later while three (5%) in the Senning group died early and two (4%) died late. Pulmonary venous obstruction developed in four (6%) patients in the Mustard group, all requiring reoperation. Six (11%) in the Senning group had pulmonary venous obstruction; four (7%) had a reoperation. Systemic venous obstruction occurred in 32 patients in the Mustard group; reoperation was required in 11 (17%). Seven patients in the Senning group had systemic venous obstruction and three (5%) required reoperation. No patient in either group required reoperation for intracardiac shunts. One patient from each group died with sick sinus syndrome. Only two patients had transient right ventricular failure, both after the Senning repair. No patient in either group had tricuspid regurgitation. Recognizing the limitations inherent in comparing operations performed during separate time periods, the improvement in early operative mortality with the Senning operation makes it the intraatrial baffle procedure of choice for d-transposition of the great arteries with intact ventricular septum at our institution. Additionally, the use of autologous tissue with the Senning technique may prevent the progression of late baffle obstruction observed in some patients years after the Mustard operation. Until the long-term results are known, however, choice of operation is based on surgical preference.