APPRAISAL OF THE MUSTARD PROCEDURE FOR THE PHYSIOLOGICAL CORRECTION OF SIMPLE TRANSPOSITION OF THE GREAT-ARTERIES - 80 CONSECUTIVE CASES, 1970-1980

  • 1 January 1981
    • journal article
    • research article
    • Vol. 82  (3) , 436-446
Abstract
Eighty successive patients underwent the Mustard operation for simple transposition of the great arteries (TGA) between Jan. 1970, and Jan. 1980. Ages ranged from 42 days to 12.4 yr (mean 14.7 mo.). Balloon atrial septostomy (BAS) with balloon volumes of more than 2.5 ml produced significant increases of arterial O2 saturation, although the initial benefit of BAS was greater than that found at follow-up catheterization. In these patients the left ventricular (LV) pressure tended to decrease during the 1st mo. of life, but this drop was less marked at the end of the 1st yr. Deep hypothermia and cardiocirculatory arrest were employed in all cases. Several modifications were adapted to the original surgical technique to reduce late sequelae. There were 2 early and 3 late deaths. At follow-up (mean 4.5 yr) 74% of patients were symptom-free. Sinoatrial and atrioventricular (AV) conduction disturbances were present in 5 and 6 patients, respectively. Caval or pulmonary venous obstruction occurred in 13 patients, 7 of whom required reoperation. Isolated tricuspid valve incompetence was present in 1 patient only, but in 4 it was associated with other defects. Primary right ventricular (RV) failure occurred in 1 patient. These findings, in relation to mortality, complications and the excellent clinical results in the majority of survivors, compare favorably with results published for patients with simple TGA who have been subjected to other types of physiological or anatomic correction. There seems to be no good reason to alter the surgical policy in this group of patients.