Outcomes of transposition of the great arteries in the ear of atrial inflow correction

Abstract

Objective: To examine long term morbidity and mortality following atrial inflow corrective procedures for transposition of the great arteries (TGA) and to investigate factors that influence morbidity and mortality.

Design: Retrospective cohort study from a single centre.

Setting: Cardiology and cardiothoracic surgical unit in a large tertiary referral centre.

Patients: All 130 patients who had TGA diagnosed between August 1972 and May 1988 and were considered suitable for atrial inflow correction; 109 of these underwent surgery (operative cohort: 84 Mustard operations and 25 Senning operations); 95 survived to hospital discharge (hospital surviving cohort).

Main outcome measures: Death and cardiac events.

Results: There were relatively good long term results from atrial inflow correction for TGA with 5, 10, and 15 year survivals of 77.3%, 75.9%, and 71.3%. However, there was an appreciable incidence of late cardiac death and events, with 5, 10, and 15 year cardiac event-free survivals of 74.5%, 67.1%, and 39.6%. Supraventricular tachycardia was the only significant risk factor for late cardiac death (relative risk 8.72, 95% confidence interval, 2.86 to 26.64). Senning patients had better event-free survival (p = 0.04).

Conclusions: Atrial inflow correction for TGA has a reasonably good 15 year survival (71.3%), but there is an appreciable incidence of late cardiac deaths and events (15 year event-free survival 39.6%). The Senning procedure is preferable to the Mustard procedure for cases unsuitable for arterial switching.

Figure 1

Kaplan-Meier survival curve of operative cohort (n = 109).

Figure 2

Event-free survival: comparison of Mustard and Senning cohorts (after adjustment for date of operation).

Figure 3

Kaplan-Meier curve of long term survival in sinus rhythm (hospital surviving cohort, n = 95).