What question did this study set out to answer?

This study aims to evaluate the long-term survival, clinical outcomes, and right ventricular function after the Mustard procedure for transposition of the great arteries.

April 23, 2026Open Access

Decline in ventricular function and clinical condition after mustard repair for transposition of the great arteries (a prospective study of 22?29 years)*1

Key Result

Mustard repair for transposition of the great arteries leads to long-term systemic right ventricular failure, declining clinical status, and expected increased mortality or need for transplant.

Key Points

This study aims to evaluate the long-term survival, clinical outcomes, and right ventricular function after the Mustard procedure for transposition of the great arteries.
Prospective study of 91 patients who underwent the Mustard procedure between 1973 and 1980.
Patients were assessed 14 years and 25 years post-surgery using ECG, echocardiography, exercise testing, and Holter monitoring.
Survival and event-free survival rates were calculated.
Cumulative survival after 25 years was 77%, with event-free survival at 36%.
Reoperation was necessary for 46% of patients.
61% showed moderate-to-severe right ventricular dysfunction after 25 years, and exercise capacity declined.

Structured PICO

What is the long-term ventricular function and clinical condition of patients after Mustard repair for transposition of the great arteries?

Population

Patients after Mustard repair for transposition of the great arteries

Intervention

Long-term follow-up after Mustard repair

Outcome

Ventricular function and clinical condition

Long-term follow-up (22-29 years) after Mustard repair for transposition of the great arteries shows declining right ventricular function and clinical condition, anticipating increased mortality or need for heart transplantation.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

BACKGROUND: Great concern exists about the ability of the anatomic right ventricle to sustain the systemic circulation in patients with transposition of the great arteries who have undergone a Mustard procedure. A prospective study was made to examine long-term survival, clinical outcome, and right ventricular function 25 years after surgery. METHODS: Ninety-one consecutive patients underwent the Mustard procedure between 1973 and 1980. After 14 years and again after 25 years (range 22-29 years), patients were studied with ECG, echocardiography, exercise testing, and Holter monitoring. RESULTS: The cumulative survival and event-free survival were 77% and 36%, respectively, after 25 years. Reoperation was necessary in 46%. No major loss of sinus rhythm was found. While all patients had good right ventricular function 14 years after repair, 61% of patients showed moderate-to-severe dysfunction after 25 years, when studied by echocardiography. Furthermore, the QRS complex widened and exercise capacity decreased. CONCLUSION: The anatomic right ventricle appears to be unable to sustain the systemic circulation at long-term follow-up and the clinical condition of patients late after Mustard repair is declining. We can expect more deaths or need for heart transplantation in the next decade.