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The Journal of Thoracic and Cardiovascular Surgery, Vol 95, 717-726, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WG Williams, GA Trusler, JW Kirklin, EH Blackstone, JG Coles, T Izukawa and RM Freedom
Inferences: A treatment protocol for patients with simple transposition,
consisting of initial balloon atrial septostomy and leading to a delayed
atrial switch repair of the Mustard type, in good circumstances, results in
survivorship at 1 month, 1 year, 10 years, and 20 years of 95% (95%
confidence limits [CL] 90% to 97%), 90% (95% CL 84% to 94%), 83% (95% CL
74% to 90%), and 80% (95% CL 70% to 88%), respectively. Low birth weight
adversely affects survivorship. Hypoxia or heart failure accounts for most
deaths within the first month and before the atrial switch (Mustard)
repair. Most of the few deaths late postoperatively are sudden and they
appear to occur particularly in patients who have junctional rhythm. A
progressive increase in the prevalence of junctional rhythm has been a risk
of the atrial switch repair, and only 76%, 65%, 59%, 56%, and 53% of
patients can be expected to be free of this by 1, 5, 10, 15, and 20 years
after repair. Important right ventricular dysfunction late after an atrial
switch repair, with its adverse affect on the patients' functional
capacity, appears to be present in up to 10% of patients after the atrial
switch repair, but may not be an immutable risk of this type of repair.
About 90% of patients, essentially all of those who do not have right
ventricular dysfunction, can be expected to be in New York Heart
Association class I or II late postoperatively.
ARTICLES
Early and late results of a protocol for simple transposition leading to an atrial switch (Mustard) repair
Department of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
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J. C. Mendoza, S. A. Wilkerson, and A. H. Reese Follow-up of Patients Who Underwent Arterial Switch Repair for Transposition of the Great Arteries Arch Pediatr Adolesc Med, January 1, 1991; 145(1): 40 - 43. [Abstract] [PDF]
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H. Laks The arterial switch procedure for the neonate: Coming of age Ann. Thorac. Surg., July 1, 1989; 48(1): 3 - 4. [PDF]
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C. L. Backer, M. N. Ilbawi, S. Ohtake, S. Y. DeLeon, A. J. Muster, M. H. Paul, D. W. Benson Jr, and F. S. Idriss Transposition of the great arteries: A comparison of results of the Mustard procedure versus the arterial switch Ann. Thorac. Surg., July 1, 1989; 48(1): 10 - 14. [Abstract] [PDF]
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