OBJECTIVES: We analysed nationwide early and late results after the Mustard, Senning and arterial switch operation. METHODS: We included all paediatric patients (<18 years) who underwent a Senning, a Mustard or an arterial switch operation for transposition of the great arteries from 1968 to 2009 in Finland. Data were obtained retrospectively from a paediatric cardiac surgical database and population data from the Finnish national registry. RESULTS: Early mortality (<30 days) was 11% after Mustard and 5% after Senning operation, while the rate decreased from 19% during 1976-1999 to 2% during 2000-2009 for arterial switch patients (P < 0.0001). The 43-year survival rate was 75% [95% confidence interval (CI) 70-80%] for all patients and 97% (95% CI 94-98%) for the general population. Late survival improved during later eras, with a 10-year survival of 96% (95% CI 92-99%) for those operated during 2000-2009 vs 81% (95% CI 74-88%) in the 1990s (hazard ratio 3.7, 95% CI 1.4-9.6, P = 0.008). Twenty-year survival rates (without 30-day mortality) after arterial switch operation, Mustard and Senning were 97% (95% CI 95-100%), 78% (95% CI 68-87%) and 84% (95% CI 77-90%), respectively. No late sudden deaths or fatal heart failures occurred after the arterial switch operation. CONCLUSIONS: Outcome after surgery for transposition of the great arteries has improved, mostly due to the arterial switch operation but also due to improvements in perioperative care and follow-up. Operative deaths after the arterial switch operation have diminished, and no late sudden deaths or fatal heart failures occurred during the first 25-30 years after the procedure.
OBJECTIVES: We analysed nationwide early and late results after the Mustard, Senning and arterial switch operation. METHODS: We included all paediatric patients (<18 years) who underwent a Senning, a Mustard or an arterial switch operation for transposition of the great arteries from 1968 to 2009 in Finland. Data were obtained retrospectively from a paediatric cardiac surgical database and population data from the Finnish national registry. RESULTS: Early mortality (<30 days) was 11% after Mustard and 5% after Senning operation, while the rate decreased from 19% during 1976-1999 to 2% during 2000-2009 for arterial switch patients (P < 0.0001). The 43-year survival rate was 75% [95% confidence interval (CI) 70-80%] for all patients and 97% (95% CI 94-98%) for the general population. Late survival improved during later eras, with a 10-year survival of 96% (95% CI 92-99%) for those operated during 2000-2009 vs 81% (95% CI 74-88%) in the 1990s (hazard ratio 3.7, 95% CI 1.4-9.6, P = 0.008). Twenty-year survival rates (without 30-day mortality) after arterial switch operation, Mustard and Senning were 97% (95% CI 95-100%), 78% (95% CI 68-87%) and 84% (95% CI 77-90%), respectively. No late sudden deaths or fatal heart failures occurred after the arterial switch operation. CONCLUSIONS: Outcome after surgery for transposition of the great arteries has improved, mostly due to the arterial switch operation but also due to improvements in perioperative care and follow-up. Operative deaths after the arterial switch operation have diminished, and no late sudden deaths or fatal heart failures occurred during the first 25-30 years after the procedure.
Authors: Alexander Kiener; Michael Kelleman; Courtney McCracken; Lazaros Kochilas; James D St Louis; Matthew E Oster Journal: Ann Thorac Surg Date: 2018-08-31 Impact factor: 4.330
Authors: Courtney McCracken; Logan G Spector; Jeremiah S Menk; Jessica H Knight; Jeffrey M Vinocur; Amanda S Thomas; Matthew E Oster; James D St Louis; James H Moller; Lazaros Kochilas Journal: J Am Heart Assoc Date: 2018-11-20 Impact factor: 5.501