Corrective surgery of transposition of the great arteries in the first year of life: Results in 63 infants

Abstract

Sixty-three infants with transposition of the great arteries (TGA) aged 3 weeks to 12 months, have had Mustard's operation between 1967 and 1973. Their weights ranged from 3.7 to 9.5 kilograms. Fifty-two had TGA and atrial septal defect (ASD), 10 had TGA and ventricular septal defect (VSD), and 1 had TGA, VSD, and left ventricular outflow tract obstruction (LVOTO). Fifty-eight infants were operated upon with cardiopulmonary bypass, while deep hypothermia and circulatory arrest was used in 5. Fifty of 52 infants with TGA and ASD survived the operation. In the group with complex transposition, 4 out of 10 infants with VSD survived the operation. The only infant who had TGA and LVOTO survived the operation after a prolonged postoperative period. Among 17 survivors in whom pericardium was used for the patch (1967 to 1970), fatal pulmonary venous obstruction occurred in 1. In a later group of 28 infants in whom Dacron was used, all survived the operation, but 10 developed SVC and/or IVC obstruction. This was severe enough to require operative revision in 9 (one death). Since September, 1972, pericardium has been used exclusively for the patch. Our early and late results confirm the view that early primary repair in patients with simple TGA is a preferable method of treatment