Helbing W A, Hansen B, Ottenkamp J, Rohmer J, Chin J G, Brom A G, Quaegebeur J M
Department of Pediatrics (Subdivision of Pediatric Cardiology), University of Leiden, The Netherlands.
J Thorac Cardiovasc Surg. 1994 Aug;108(2):363-72.
Few data exists on the differences in long-term outcome between Mustard and Senning operations. We reviewed available data of all hospital survivors of these operations and assessed risk factors for late death and sinus node dysfunction. Of those patients undergoing the Mustard operation, 60 were hospital survivors (46 simple transposition, 14 complex); of those patients undergoing the Senning operation, 62 were hospital survivors (43 simple, 19 complex). Median duration of follow-up was 16 years (maximum 25 years) for Mustard operation, 11 years (maximum 20 years) for Senning operation. No reoperations were done, except for pacemaker implantation. No differences were found between the two groups with regard to baffle-associated problems, right ventricular failure, sudden death (6% in both groups), and functional status at final follow-up (New York Heart Association class I or II, except for four patients). For patients undergoing the Mustard operation, survival at 16-year follow-up was 91% with simple transposition and 60% with complex transposition (p = 0.027); for both groups of patients undergoing the Senning operation, survival at 16-year follow-up was 78%. Survival in the absence of rhythm disturbance at 16-year follow-up was 18% for Mustard operation and 53% for Senning operation (p < 0.001). In multivariate analysis, significant independent risk factors for late death turned out to be complex transposition (versus simple) and active arrhythmias. The only significant risk factor for the occurrence of sinus node dysfunction was the Mustard operation. We conclude that apart from the difference in the loss of sinus rhythm, no differences were found in the long-term clinical results of the two types of operations.
关于Mustard手术和Senning手术长期预后差异的数据很少。我们回顾了这些手术所有医院存活者的可用数据，并评估了晚期死亡和窦房结功能障碍的危险因素。接受Mustard手术的患者中，60例为医院存活者（46例单纯型转位，14例复杂型）；接受Senning手术的患者中，62例为医院存活者（43例单纯型，19例复杂型）。Mustard手术的中位随访时间为16年（最长25年），Senning手术为11年（最长20年）。除植入起搏器外，未进行再次手术。两组在与挡板相关的问题、右心室衰竭、猝死（两组均为6%）以及末次随访时的功能状态（纽约心脏协会I或II级，4例除外）方面未发现差异。接受Mustard手术的患者，单纯型转位16年随访时的生存率为91%，复杂型转位为60%（p = 0.027）；接受Senning手术的两组患者，16年随访时的生存率均为78%。Mustard手术16年随访时无节律紊乱的生存率为18%，Senning手术为53%（p < 0.001）。多因素分析显示，晚期死亡的显著独立危险因素为复杂型转位（与单纯型相比）和活动性心律失常。窦房结功能障碍发生的唯一显著危险因素是Mustard手术。我们得出结论，除了窦律丧失方面的差异外，两种手术的长期临床结果未发现差异。
