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J Thorac Cardiovasc Surg 1999;117:488-495
© 1999 Mosby, Inc.
SURGERY FOR CONGENITAL HEART DISEASE |
From Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki, Finland.
Received for publication March 19, 1998. Revisions requested June 1, 1998. Revisions received Sept 8, 1998. Accepted for publication Sept 10, 1998. Address for reprints: Mikko Kirjavainen, MD, Helsinki University Central Hospital, Hospital for Children and Adolescents, PL 281, Helsinki 00029 HYKS, Finland.
Objectives: Few data exist for long-term results after the Senning operation for transposition of the great arteries. Sinus node dysfunction and systemic ventricular dysfunction have been the main problems. We evaluated risk factors for late death and the incidence of late death, sinus node dysfunction, and right ventricular dysfunction in 100 patients.
Methods: The study was a retrospective analysis with a mean follow-up time of 12.8 ± 3.1 years. No patients were lost to follow-up. Patients were divided in 2 groups according to ventricular septal defect (73 simple, 27 complex). The electrocardiogram, ambulatory electrocardiogram, echocardiogram, and chest radiograph were reviewed for each patient.
Results: The overall mortality rate was 10%. The actuarial survival was 90% (simple) and 78% (complex); the probability of staying in sinus rhythm was 34% and 7%, and the probability of normal right ventricular function was 52% and 39%, respectively, 15 years after operation. The incidence of sinus node dysfunction increased gradually over time, although the incidence of right ventricular dysfunction increased rapidly after 10 years of follow-up. Late deaths, arrhythmias, and right ventricular dysfunction were significantly more frequent in the complex group. Right ventricular dysfunction and active arrhythmias were risk factors for late death.
Conclusion: Long-term follow-up after the Senning operation shows increasing incidence of sinus node dysfunction and right ventricular dysfunction over time. Deteriorating right ventricular function is a major concern. Its early recognition and initiation of appropriate management to preserve cardiac function is an important follow-up goal.
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