306 20 years of follow-up in 132 Senning procedures: late results

Abstract

Senning procedure was performed for the first time in France at Bordeaux University Hospital in 1965. Follow up have come out focusing on failing systemic right ventricle and rhythmic complication. The aim of this work is to identify prognosis factors of reoperation, arrhythmias and right ventricular dysfunction. This single institution study is a retrospective analysis of 132 patients, with simple (105 patients) and complex (27 patients) transposition of the great arteries, after a Senning procedure between 1977 and 2004. The mean follow-up time was 19.5 ± 6.6 years. Conventional follow up and testing were performed in the same unit. An isotopic ventriculography or MRI was done for 70 patients to investigate the systemic right ventricular function. Operative mortality was 5.3%. Late mortality was 9.6%. 9 patients underwent a single reoperation and one needs heart transplantation. Actuarial survival rate was 91.5%, 91%, 89% and 88% at respectively 1, 5, 10, and 20 years. There is no statistically difference between simple and complex transposition for actuarial survival rate, maintaining permanent sinus rhythm or arrhythmias occurrence. After 20 years of 98% of patients in simple transposition group have ejection fraction > 40% versus 58% in complex transposition (p<0.001). Risk factors of ventricular dysfunction were complex transposition (p<0.001) and absence of cardioplegia (p<0.001). Last follow-up showed 91% in NYHA class 1. Imaging systemic right ventricular dysfunction (FEVD<40%) was yet uncommon at 20 years of follow-up but is not sufficient to predict a good response of this ventricle to stress and effort. Long term follow-up after the Senning operation shows frequent and increasing incidence of sinus node dysfunction and others arrhythmias: these complications are expected in double switch procedure.