Myridakis D J, Ehlers K H, Engle M A
Dr. Mary Allen Engle Division of Pediatric Cardiology, New York Hospital-Cornell University Medical College, New York.
Am J Cardiol. 1994 Nov 15;74(10):1030-6. doi: 10.1016/0002-9149(94)90854-0.
Most adolescents and young adults born with complete transposition of the great arteries (TGA) and alive today are survivors of the Mustard operation. This study reports on the serial, long-term (from 10 to > 20 years) follow-up of 85 patients who underwent this operation between 1971 and 1981. Of these, 63 had simple and 22 complex TGA. The age at surgery ranged from 2 days to 17 years. The early mortality rate was 10.5% and the late mortality 9.2%. The actuarial survival rate after 15 years was 86% for simple and 64% for complex TGA. Event-free survival after 15 years was 77% for simple and 46% for complex TGA. Yearly review of electrocardiograms and, less frequently, of Holter tracings disclosed a lower mean resting heart rate and decrease over time in sinus rhythm and an increase in active arrhythmias. Fifty-two percent had resting sinus rhythm and 17% had active arrhythmias at 16 to 20 years of follow-up. Exercise stress testing in 21 patients revealed resumption of sinus rhythm during exercise but significant diminution of endurance time and peak heart rate response. Seven of the survivors (9.2%) required reoperation. Of these, 4 had severe tricuspid regurgitation following patch closure of ventricular septal defect. This study shows gratifying long-term and event-free survival for the majority of patients who underwent surgery by this venous switch procedure.
大多数患有完全性大动脉转位（TGA）且存活至今的青少年和年轻成人都是Mustard手术的幸存者。本研究报告了1971年至1981年间接受该手术的85例患者的系列长期（10至20多年）随访情况。其中，63例为单纯性TGA，22例为复杂性TGA。手术年龄从2天至17岁不等。早期死亡率为10.5%，晚期死亡率为9.2%。单纯性TGA患者15年后的精算生存率为86%，复杂性TGA患者为64%。15年后无事件生存率，单纯性TGA患者为77%，复杂性TGA患者为46%。每年对心电图进行复查，较少对动态心电图记录进行复查，结果显示静息心率均值较低，窦性心律随时间下降，主动性心律失常增加。在随访16至20年时，52%的患者有静息窦性心律，17%的患者有主动性心律失常。对21例患者进行运动负荷试验，结果显示运动期间窦性心律恢复，但耐力时间和心率峰值反应显著降低。7名幸存者（9.2%）需要再次手术。其中，4例在室间隔缺损补片闭合后出现严重三尖瓣反流。本研究表明，大多数接受这种静脉调转手术的患者长期生存且无事件发生，结果令人满意。
