Senning and mustard atrial switch procedures: Long term follow-up, morbidity and complications

Aims: Since the introduction of anatomical correction for transposition of great arteries (TGA), the Senning or Mustard atrial swich procedures have lost their surgical importance. More and more, TGA patients who underwent atrial switch procedures are presented in specialized GUCH ambulances.

Methods: Retrospectively, data from 46 patients after Senning-and 33 patients after Mustard operation were evaluated regarding operative outcome, early postoperative phase and long term follow-up (FU; mean patient age at controls 18.8 years, mean FU 17.6 years).

Results: Long-term FU mortality (maximum of 28 years) was 11.9% for Senning-and 39.3% for Mustard patients (p=0.01*). Postoperative interventions were indicated – mainly due to systemic or pulmonary venous obstructions – in 34.3% of all patients. Senning patients needed less frequently reoperations than Mustard patients (7.1% vs. 46.4%, p=0.001*). Furthermore, we registered (mainly supra-ventricular) episodic or permanent arrhythmias in 78.6% of our patients, 40% were symptomatic. The Senning-group was more frequently and to a certain extent previously affected (6.9 vs. 13.3 years, p=0.013*). Antiarrhythmics were administered to 41.4% of the whole cohort, 35.7% of all patients received a permanent pacemaker. Severe tricuspid regurgitation was significantly associated with right ventricular dysfunction (p=0.006*). A moderate to severe right ventricular dysfunction occurred in 35.7%, supra ventricular arrhythmias increased the risk by three times. 80% of our patients were allocated to NYHA I at the last follow-up, 81.4% had an ability index of 1.

Conclusion: Regular and accurate controls in specialized GUCH facilities represent a substantial necessity after atrial switch procedures in order to prevent complications.