OUTCOMES OF TRANSPOSITION OF THE GREAT-ARTERIES IN THE ERA OF ATRIAL INFLOW CORRECTION

Objective-To examine long term morbidity and mortality following atria l inflow corrective procedures for transposition of the great arteries (TGA) and to investigate factors that influence morbidity and mortali ty. Design-Retrospective cohort study from a single centre. Setting-Ca rdiology and cardiothoracic surgical unit in a large tertiary referral centre. Patients-All 130 patients who had TGA diagnosed between Augus t 1972 and May 1988 and were considered suitable for atrial inflow cor rection; 109 of these underwent surgery (operative cohort: 84 Mustard operations and 25 Senning operations); 95 survived to hospital dischar ge (hospital surviving cohort). Main outcome measures-Death and cardia c events. Results-There were relatively good long term results from at rial 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-f ree 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 c orrection for TGA has a reasonably good 15 year survival (71.3%), but there is an appreciable incidence of late cardiac deaths and events (1 5 year event-free survival 39.6%). The Senning procedure is preferable to the Mustard procedure for cases unsuitable for arterial switching.