This Article Full Text Full Text (PDF) All Versions of this Article: 114/18/1905    most recent CIRCULATIONAHA.105.606046v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lange, R. Articles by Schreiber, C. Search for Related Content PubMed PubMed Citation Articles by Lange, R. Articles by Schreiber, C. Related Collections Other heart failure Pediatric and congenital heart disease, including cardiovascular surgery Related Article

(Circulation. 2006;114:1905-1913.)
© 2006 American Heart Association, Inc.

Cardiovascular Surgery

Presence of a Ventricular Septal Defect and the Mustard Operation Are Risk Factors for Late Mortality After the Atrial Switch Operation

Thirty Years of Follow-Up in 417 Patients at a Single Center

Rüdiger Lange, MD, PhD^*; Jürgen Hörer, MD^*; Martin Kostolny, MD; Julie Cleuziou, MD; Manfred Vogt, MD, PhD; Raymonde Busch, MSc; Klaus Holper, MD, PhD; Hans Meisner, MD, PhD; John Hess, MD, PhD; Christian Schreiber, MD, PhD

From the Departments of Cardiovascular Surgery (R.L., J.H., M.K., J.C., K.H., H.M., C.S.) and Pediatric Cardiology and Congenital Heart Disease (M.V., J.H.), German Heart Center Munich, and Institute of Medical Statistics and Epidemiology (R.B.), Technical University Munich, Munich, Germany.

Correspondence to Jürgen Hörer, MD, Department of Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, D-80636 Munich, Germany. E-mail hoerer{at}dhm.mhn.de

Received December 6, 2005; revision received August 16, 2006; accepted September 8, 2006.

Background— Survival and functional status of patients with transposition of the great arteries treated by atrial switch are reported to be reasonably good within the first 15 postoperative years. However, in some patients, the function of the systemic right ventricle deteriorates, leading to significant morbidity or even to late mortality. This study seeks to identify risk factors for late death.

Methods and Results— Records of 329 patients after the Senning operation and 88 after the Mustard operation at a single center were retrospectively reviewed for demographic, anatomic, and echocardiographic predictors and outcomes. Mean follow-up interval was 19.1±6.5 years and was 95% complete. Survival 25 years after the Mustard procedure was 75.9±4.8% and after the Senning procedure was 90.9±2.3% (P=0.002). Mustard patients died more often of arrhythmia than Senning patients (P<0.001) and needed more baffle-related reoperations (P<0.0001). Ventricular septal defect closure at the time of the atrial switch operation (hazard rate=2.3; 95% confidence interval, 1.1 to 4.7; P=0.025) and the Mustard operation (hazard rate=2.0; 95% confidence interval, 1.01 to 3.8; P=0.045) emerged as independent risk factors for late mortality in multivariate analysis. At follow-up, 85.8% of the patients led a normal life with full-time work, and 11.8% were able to do part-time work. Only 2.4% experienced noticeable limitation of activities.

Conclusions— Our patient data reveal satisfactory results at long term in this historic collective. Patients who had undergone ventricular septal defect closure at the time of the atrial switch operation and those who had undergone a Mustard operation are at higher risk for late death. Close follow-up, especially of these subgroups, is warranted.

---

 

CLINICAL PERSPECTIVE

Related Article:

Issue Highlights
Circulation 2006 114: 1897. [Extract] [Full Text]

This article has been cited by other articles:

				M. Schwerzmann, O. Salehian, L. Harris, S. C. Siu, W. G. Williams, G. D. Webb, J. M. Colman, A. Redington, and C. K. Silversides Ventricular arrhythmias and sudden death in adults after a Mustard operation for transposition of the great arteries Eur. Heart J., August 1, 2009; 30(15): 1873 - 1879. [Abstract] [Full Text] [PDF]

				A. Giardini, A. Hager, A. E. Lammers, G. Derrick, J. Muller, G.-P. Diller, K. Dimopoulos, D. Odendaal, G. Gargiulo, F. M. Picchio, et al. Ventilatory efficiency and aerobic capacity predict event-free survival in adults with atrial repair for complete transposition of the great arteries. J. Am. Coll. Cardiol., April 28, 2009; 53(17): 1548 - 1555. [Abstract] [Full Text] [PDF]

				J. Horer, C. Schreiber, J. Cleuziou, M. Vogt, Z. Prodan, R. Busch, K. Holper, and R. Lange Improvement in long-term survival after hospital discharge but not in freedom from reoperation after the change from atrial to arterial switch for transposition of the great arteries. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 347 - 354. [Abstract] [Full Text] [PDF]

				J. Horer, E. Karl, G. Theodoratou, C. Schreiber, J. Cleuziou, Z. Prodan, M. Vogt, and R. Lange Incidence and results of reoperations following the Senning operation: 27 years of follow-up in 314 patients at a single center Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1061 - 1067. [Abstract] [Full Text] [PDF]

				E. Bedard, D. F. Shore, and M. A. Gatzoulis Adult congenital heart disease: a 2008 overview Br. Med. Bull., March 1, 2008; 85(1): 151 - 180. [Abstract] [Full Text] [PDF]

				T. P. Graham Jr The Year in Congenital Heart Disease J. Am. Coll. Cardiol., July 24, 2007; 50(4): 368 - 377. [Full Text] [PDF]