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Long-term outcome after senning operation for transposition of the great arteries
No full textAbstract
BACKGROUND: The Senning operation for transposition of the great arteries (TGA) was first introduced by Senning in 1959 and was revived by Quaegebeur et al. in the late 1970s, thus becoming the intervention of choice for the correction of TGA in many centers.
HYPOTHESIS: The purpose of this study was to evaluate the long-term follow-up of a group of patients undergoing surgery with the Senning procedure for TGA.
METHODS: From November 1978 to November 1987, 73 consecutive patients underwent the Senning operation. The 70 survivors had an average follow-up of 19 years (16-25 years).
RESULTS: (1) Cardiac rhythm: with time there was a progressive decrease in stable sinus rhythm (60% after 20 years) and a progressive increase of supraventricular tachyarrhythmias requiring therapy (10% after 20 years). (2) Right ventricular function: 20% of the patients had reduced ejection fraction. (3) Late mortality: in the last 12 years of follow-up years there were two sudden deaths (2.8%). (4) Functional status: 80% of patients were in NYHA class I, 17% in class II, and 3% in class III.
CONCLUSIONS: Our results confirm that the patients who undergo the Senning procedure have a progressive loss of sinus rhythm, an increase in active arrhythmias, and other important adverse outcomes such as late sudden death and a decrease in right ventricular function; however, most patients (93% in our series) are alive and in good functional status
Long term outcome up to 30 years after the Mustard or Senning operation: a nationwide multicentre study in Belgium.
No full textOBJECTIVE: To assess long term outcome of patients who underwent Mustard or Senning repair for transposition of the great arteries up to 30 years earlier. DESIGN: Retrospective review of medical records. SETTING: The six university hospitals in Belgium with paediatric cardiology departments. PATIENTS: 339 patients were reviewed, of whom 124 underwent the Mustard procedure and 215 the Senning procedure. This represents almost the entire population of patients in Belgium with either simple or complex transposition. MAIN OUTCOME MEASURES: Mortality, morbidity, functional abilities, social integration. RESULTS: Overall mortality was 24.2%. Early mortality (< or = 30 days after surgery) accounted for 16.5%, late mortality for 7.7%. Actuarial survival of early survivors at 10, 20, and 30 years after surgery was 91.7%, 88.6%, and 79.3%, respectively. Patients in the Senning cohort had a slightly better survival rate than those in the Mustard cohort (NS). Baffle obstruction occurred more often after Mustard repair (15.3%) than after the Senning procedure (1.4%). Arrhythmia-free survival did not differ between the two cohorts, but was determined by the complexity of the transposition. Survivors of the Senning cohort had better functional status, and tended to engage in more sports activities. CONCLUSIONS: The long term outcome for patients surviving the Mustard or Senning operation was favourable in terms of late mortality, morbidity, functional, and social status. Overall mortality in the Senning cohort did not differ from the Mustard group, but Senning patients had better functional status, greater participation in sports activities, and fewer baffle related problems
Long-term Folllow-Up after Mustard- and Senning-Operation for patients with d-TGA
No full textEinleitung: Diese Studie erfasst den Langzeitverlauf von Mustard- und Senning-Patienten mit d-Transposition der großen Arterien (d-TGA), die an der Charité Berlin Campus Virchow-Klinikum und am Deutschen Herzzentrum Berlin betreut werden.
Patienten mit Vorhofumkehroperation stellen ein komplexes Patientenkollektiv dar. Die Dysfunktion des rechten Systemventrikels und die assoziierten hämodynami-schen und rhythmologischen Probleme beeinflussen im Langzeitverlauf Morbidität, Mortalität und Lebensqualität.
Methodik: Retrospektive Analyse klinischer und paraklinischer Parameter und Erfas-sung der Lebensqualität und Belastbarkeit mittels eines selbstentworfenen Fragebo-gens. Zweimalige Datenakquise (2009 und 2015) bei insgesamt 123 Patienten (81 Senning-, 42 Mustard-Patienten), davon 72 mit einfacher und 51 Patienten mit kom-plexer d-TGA. 2015 konnten davon noch 67 Patienten (48 Senning-, 19 Mustard-Patienten) eingeschlossen werden.
Ergebnisse: Das mittlere Alter zum Zeitpunkt der Datenerhebung 2009 betrug 24,6 ± 4,0 Jahren (2015: 29,8 ± 4,2 Jahren). Im NYHA-Stadium I und II waren 2009 90,4 % der Mustard- und 91,4 % der Senning-Patienten, 2015 84,2 % der Mustard- und 87,6 % der Senning-Patienten. Im NYHA-Stadium IV befand sich kein Patient. Eine milde Trikuspidalklappeninsuffizienz (TI) war 2009 bei 51,6 % der Mustard- und 52,9 % der Senning-Patienten, 2015 bei 78,9 % der Mustard- und 72,9 % der Sen-ning-Patienten nachweisbar. Eine moderate und schwere TI wurde 2009 bei 48,4 % der Mustard- und 47,2 % der Senning-Patienten und 2015 bei 21,1 % der Mustard- und 27,1 % der Senning-Patienten dokumentiert. Eine normale rechtsventrikuläre Funktion wurde 2009 bei 16,1 % der Mustard- und 13,4 % der Senning-Patienten und 2015 bei 21,1 % der Mustard- und 15,9 % der Senning-Patienten dargestellt. Eine hochgradige rechtsventrikuläre Dysfunktion bestand 2009 bei 6,5 % der Mustard- und 17,9 % der Senning-Patienten, 2015 bei 10,5 % der Mustard- und 31,8 % der Sen-ning-Patienten.
Die häufigste eruierte Herzrhythmusstörung war zu beiden Zeitpunkten das Sick-Sinus-Syndrom (SSS). 2009 hatten 72,3 % (61,3 % der Mustard- und 77,1 % der Sen-ning-Patienten) und 2015 44,8 % (26,3 % der Mustard- und 52,1 % der Senning-Patienten) der Patienten ein SSS. Die Spätletalität liegt bei 15,4 %. Die Überlebens-wahrscheinlichkeit ist bei den nach Senning operierten Patienten signifikant höher.
Schlussfolgerung: Die kumulative Überlebensrate nach Kaplan-Meier ist für Mustard-Patienten nach 30 Jahren nach Vorhofumkehroperation 83,3 %, für Senning-Patienten 86,4 %. Jedoch ist die Mortalitätsrate bei den Mustard- mehr als doppelt so hoch wie bei den Senning-Patienten. Trotz hoher Morbidität befinden sich über 80 % der Patienten beider Gruppen in einem guten NYHA-Stadium.Objective: This study assessed a long-term follow-up of Mustard and Senning patients with d-transposition of the great arteries (d-TGA) being cared for at the Charité Berlin Campus Virchow-Klinikum and German Heart Center Berlin.
Patients with atrial correction represent a complex collective of patients. The dysfunc-tion of the right ventricle and the associated hemodynamic and rhythm problems influ-ence morbidity, mortality and quality of life in long term follow-up.
Methods: Retrospective analysis of clinical and paraclinical parameters and assess-ment of quality of life and functional status using a self-designed questionnaire. Two data acquisitions (2009 and 2015) from 123 patients (81 Senning, 42 Mustard pa-tients). Of these, 72 with simple and 51 patients with complex d-TGA. 2015 67 of these patients were included (48 Senning and 19 Mustard patients).
Results: The median age at the time of data collection in 2009 was 24.6 ± 4.0 years, (2015: 29.8 ± 4.2) years. In NYHA stages I and II, 90.4% of Mustard's and 91.4% of Senning's patients in 2009, 84.2% of Mustard's and 87.6% of Senning's patients in 2015, respectively. There was no patient in NYHA Stage IV. Mild tricuspid valve regur-gitation (TR) was detectable in 51.6% of Mustard and 52.9% of Senning patients in 2009, and in 78.9% of Mustard and 72.9% of Senning patients in 2015. Moderate and severe TR was documented in 2009 in 48.4% of Mustard and 47.2% of Senning pa-tients and in 21.1% of Mustard and 27.1% of Senning patients in 2015. Normal right ventricular function was reported in 16.1% of Mustard and 13.4% of Senning patients in 2009 and 21.1% of Mustard and 15.9% of Senning patients in 2015. Severe right ventricular dysfunction was 6.5% of Mustard and 17.9% of Senning patients in 2009, 10.5% of Mustard and 31.8% of Senning patients in 2015.
Sick sinus syndrome (SSS) was the most common arrhythmia at both points in time. In 2009, 72.3% (61.3% of Mustard's and 77.1% of Senning's patients) and in 2015, 44.8% (26.3% of Mustard's and 52.1% of Senning's patients) of patients had an SSS. The late mortality rate is 15.4%. Survival rate is significantly higher in Senning operat-ed patients.
Conclusion: The Kaplan-Meier cumulative survival rate for Mustard patients is 83.3% after 30 years after the atrial correction, and 86.4% for Senning patients, but the mor-tality rate in Mustard patients is more than twice as high the Senning patient. Despite high morbidity, more than 80% of the patients in both groups are in a good NYHA class
Long term outcome up to 30 years after the Mustard or Senning operation : a nationwide multicentre study in Belgium
No full textAbstract: Objective: To assess long term outcome of patients who underwent Mustard or Senning repair for transposition of the great arteries up to 30 years earlier. Design: Retrospective review of medical records. Setting: The six university hospitals in Belgium with paediatric cardiology departments. Patients: 339 patients were reviewed, of whom 124 underwent the Mustard procedure and 215 the Senning procedure. This represents almost the entire population of patients in Belgium with either simple or complex transposition. Main outcome measures: Mortality, morbidity, functional abilities, social integration. Results: Overall mortality was 24.2%. Early mortality (less than or equal to30 days after surgery) accounted for 16.5%, late mortality for 7.7%. Actuarial survival of early survivors at 10, 20, and 30 years after surgery was 91.7%, 88.6%, and 79.3%, respectively. Patients in the Senning cohort had a slightly better survival rate than those in the Mustard cohort (NS). Baffle obstruction occurred more often after Mustard repair (15.3%) than after the Senning procedure (1.4%). Arrhythmia-free survival did not differ between the two cohorts, but was determined by the complexity of the transposition. Survivors of the Senning cohort had better functional status, and tended to engage in more sports activities. Conclusions: The long term outcome for patients surviving the Mustard or Senning operation was favourable in terms of late mortality, morbidity, functional, and social status. Overall mortality in the Senning cohort did not differ from the Mustard group, but Senning patients had better functional status, greater participation in sports activities, and fewer baffle related problems
Correção cirúrgica para reversão de operação de Senning em caso de falência ventricular direita Surgical correction for atrial inversion in Senning operation in case of right ventricular dysfunction
No full textOs autores apresentam uma nova proposta para tratar disfunção do ventrículo direito no pós-operatório tardio da transposição das grandes artérias associada a grande comunicação interventricular e que tenha sido tratada pela inversão em nível atrial. Apresentam o caso de um paciente com 12 anos de idade, que havia sido submetido a operação de Senning associada a fechamento de comunicação interventricular e alivio de estenose pulmonar há 8 anos. A operação de Senning foi desfeita, restabelecendo-se a concordância atrioventricular, o remendo que fechava a comunicação interventricular foi ressecado, conectando-se a aorta com o ventrículo esquerdo. A artéria pulmonar foi seccionada transversalmente, próximo ao plano valvar. O coto proximal foi suturado e o distai, conectado ao ventrículo direito através de tubo valvulado de pericárdio bovino. A evolução foi satisfatória, revertendo-se a situação do paciente do grupo funcional IV para grupo I/II.A new proposal for the treatment of right ventricular dysfunction in late postoperative period of patients submitted to Senning operation is presented. The technique could be used in cases originally with transposition of the great arteries associated with pulmonary stenosis and a large VSD. A 12-year-old patient, who had been submitted, 8 years before, to an atrial inversion associated with closure of a large VSD and relieve of a pulmonary stonosis was submitted to this new operation. Senning operation was undone thus reestablishing atrio-ventricular concordance; the patch used for closure of VSD was removed, and the aorta was connected to the left-ventricle. Pulmonary artery was cut transversally, adjacent to the valvar horizontal plane. The proximal extremity was sutured and the distal was connected to the right ventricle through a valvar tube graft of bovine pericardium. The clinical course was uneventful and the patient improved from functional class IV to I/II
A teljes nagyér-transzpozíción átesett betegek Senning- és Mustard-féle műtéti megoldásának hosszú távú utánkövetése. Eredmények a CSONGRAD Regiszterből
No full textAbsztrakt
Bevezetés: A teljes nagyér-transzpozíció az egyik leggyakoribb,
cyanosissal járó veleszületett szívfejlődési rendellenesség.
Célkitűzés: A szerzők célja a teljes nagyér-transzpozíció
miatt Senning- és Mustard-féle műtéten átesett betegeik hosszú távú túlélésének,
funkcionális stádiumának, aritmológiai kontrolljának és életminőségének elemzése
és összehasonlítása volt. Módszer: A vizsgálatban 85, teljes
nagyér-transzpozíció miatt operált beteg vett részt, közülük 37 esetben
Senning-műtét, míg 48 esetben Mustard-műtét történt. Valamennyi esetben
utánkövetéses vizsgálatot végeztek. Eredmények: A több
évtizedes utánkövetés sikeraránya 74%-nak bizonyult. A 31 utánkövetett
Senning-műtött közül 12-en hunytak el a követés során (39%), míg a 32
Mustard-műtött közül 16-an haláloztak el (50%) (p = 0,45). Nem volt különbség a
szívelégtelenség és az aritmiák jellemzői között sem a két betegcsoportban. Az
életminőséget és a funkcionális kapacitást jellemző paraméterek kedvezőbbnek
bizonyultak a Senning-műtött betegekben. Következtetések: A
Mustard- és Senning-műtött TGA-betegek mortalitásában és morbiditásában
szignifikáns különbség nem volt igazolható. A Senning-műtött betegek
életminősége és funkcionális kapacitása a hosszú távú követés eredményei alapján
kedvezőbb. Orv. Hetil., 2016, 157(3), 104–110
Noncompaction of the right ventricle following Senning repair
No full textA three-year-old boy presented with generalized edema, respiratory distress, prominent right ventricular impulse and hepatosplenomegaly. He had undergone Senning repair at one year of age. On his echocardiography, there were numerous prominent trabeculations and deep intertrabecular recesses measuring approximately 5 mm in depth along the free wall and right ventricular apex. Echogenicity of the endocardial surface was increased suggesting a fibrotic process in progress. Intertrabecular recesses were observed to be filling from the ventricle by color Doppler which is consistent with noncompaction. Various semilunar valve obstructions were shown to be responsible for the persistence of deep endomyocardial spaces surrounded by exeggerated hypertrophy of the trabeculae. This report presents the echocardiographic findings of right ventricular cardiomyopathy associated with dextroposition of the great arteries following Senning operation resembling noncompaction. Thus, this rare entity needs to be clarified regarding morphological criteria in distinction from other cardiomyopathies
Late results of senning operation
No full textAbstractObjectives: Few data exist for long-term results after the Senning operation for transposition of the great arteries. Sinus node dysfunction and systemic ventricular dysfunction have been the main problems. We evaluated risk factors for late death and the incidence of late death, sinus node dysfunction, and right ventricular dysfunction in 100 patients. Methods: The study was a retrospective analysis with a mean follow-up time of 12.8 ± 3.1 years. No patients were lost to follow-up. Patients were divided in 2 groups according to ventricular septal defect (73 simple, 27 complex). The electrocardiogram, ambulatory electrocardiogram, echocardiogram, and chest radiograph were reviewed for each patient. Results: The overall mortality rate was 10%. The actuarial survival was 90% (simple) and 78% (complex); the probability of staying in sinus rhythm was 34% and 7%, and the probability of normal right ventricular function was 52% and 39%, respectively, 15 years after operation. The incidence of sinus node dysfunction increased gradually over time, although the incidence of right ventricular dysfunction increased rapidly after 10 years of follow-up. Late deaths, arrhythmias, and right ventricular dysfunction were significantly more frequent in the complex group. Right ventricular dysfunction and active arrhythmias were risk factors for late death. Conclusion: Long-term follow-up after the Senning operation shows increasing incidence of sinus node dysfunction and right ventricular dysfunction over time. Deteriorating right ventricular function is a major concern. Its early recognition and initiation of appropriate management to preserve cardiac function is an important follow-up goal. (J Thorac Cardiovasc Surg 1999;117:488-95
Tissue plasminogen activator for a left atrial thrombus after Senning repair
No full textTo avoid the surgical removal of an obstructive thrombus in a Senning baffle by the administration of recombinant tissue-type plasminogen activator
Case report Congenital heart failure after the Senning operation. Case report
No full textFrom the early 1960s to the mid 1980s, the Mustard and Senning procedures were the treatment of choice for transposition of the great arteries (d-TGA).
We report a case of a young girl who had undergone surgical repair of complete transposition by the Senning procedure in the early infancy. Twelve years later she developed a congestive heart failure. Based on the x-ray, echo and angiography study she was qualified for reoperation at German Heart Institute Berlin with a very good result.
Long term follow-up of patients who underwent Mustard or Senning repair for d-TGA leads to identification of multiple residua and sequelae, as well as functional problems associated with these two procedures. Our patient illustrates the effective therapy which can improve the quality of life and postpone the time for the heart transplantation
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