Arrhythmia and Mortality After the Mustard Procedure: A 30-Year Single-Center Experience
Key result
Mustard procedure survivors show ~76% 20-year survival alongside late peaks in atrial flutter and death.
- n=534
Why the study?
The Mustard operation corrects cyanosis in transposition of the great vessels with low surgical risk, but right ventricular failure, loss of sinus rhythm, atrial flutter, and death are frequent long-term complications.
What are the long-term risks of mortality and arrhythmia after the Mustard procedure in children with transposition of the great vessels?
Population
534 children who underwent the Mustard operation at a single center
Design
Single-center retrospective cohort study
Follow-up
Mean 11.6 +/- 7.2 years
Authors
Discussion
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Implication
The Mustard procedure is associated with significant long-term risks of late mortality, loss of sinus rhythm, and atrial flutter, necessitating lifelong follow-up.
Key Points
- To assess long-term risk factors associated with late mortality, loss of sinus rhythm, and the development of atrial flutter in patients who underwent the Mustard operation.
- Single-center retrospective review of 534 pediatric patients who underwent the Mustard procedure between 1962 and the study period.
- Demographic, anatomic, electrocardiographic, and physiologic predictors were analyzed in 478 early survivors over a mean follow-up of 11.6 ± 7.2 years.
- Early mortality was 9.7% (n=52), and late mortality occurred in 16.1% of early survivors (n=77, with 31 sudden deaths), yielding overall survival rates of 89% at 5 years and 76% at 20 years.
- Sinus rhythm prevalence dropped from 77% at 5 years to 40% at 20 years, with rhythm loss associated with prior septectomy, postoperative bradycardia, and atrial flutter.
- Freedom from atrial flutter declined from 92% at 5 years to 73% at 20 years, driven by perioperative bradyarrhythmia, surgical reoperation, and loss of sinus rhythm.
Study Design
Type
Cohort (n=534)
Multicenter
No
Structured PICO
What are the long-term risks of mortality and arrhythmia after the Mustard procedure in children with transposition of the great vessels?
P
Population
534 children who underwent the Mustard operation for transposition of the great vessels at a single center, with early survivors followed for a mean of 11.6 years.
E
Exposure
Mustard operation
O
Outcome
Late mortality, loss of sinus rhythm, and atrial flutterhard clinical
The Mustard procedure is associated with significant long-term risks of late mortality, loss of sinus rhythm, and atrial flutter, necessitating lifelong follow-up.
Cite This Study
Gelatt et al. (1997) conducted a cohort in Transposition of the great vessels (n=534). Mustard operation was evaluated on Late mortality. Among early survivors of the Mustard procedure, survival was 89% at 5 years and 76% at 20 years, with ongoing loss of sinus rhythm and late peaks in the risk of atrial flutter and death.