Early and Late Results with the Mustard Operation in Infancy

Abstract

Eighty-one patients, ranging in age from 36 hours to 24 months and in weight from 2.5 to 12 kg had a Mustard operation for D-transposition of the great arteries (D-TGA) (20 with complex D-TGA) using either deep hypothermic circulatory arrest (68 patients) or conventional cardiopulmonary bypass (13 patients). A Dacron patch was used for the intraatrial baffle and pericardium for augmentation of the pulmonary atrium. Ten patients died following operation. Thirty-two patients had cardiac catheterization 1 year after operation. Of 24 patients with D-TGA and intact ventricular septum, 23 had normal pulmonary artery pressures. In 20 patients left ventricular outflow tract gradients decreased from a mean of 32 mm Hg to a mean of 18 mm Hg after operation. Five patients who had D-TGA and ventricular septal defect and systemic pressures in the left ventricle before operation, had a notable decrease in left ventricular pressures after the procedure. Seven patients required reoperation for baffle obstruction. Mortality following Mustard repair was primarily related to the complexity of the lesion, maturity of the infant, and degree of pulmonary vascular changes. Caval obstruction was related to the configuration of the baffle used in the early part of this series.