Abstract
Aim of study: To evaluate the long-term results of Senning procedure for transposition of the great arteries (TGA) more than 5 years after surgery with emphasis on cardiovascular function, physical activities and quality of life. Patients: 168 patients operated on between 1984 and 1997 were followed up.
The age at surgery was from 1 month to 9 years (median 6 months). In 35 patients with complex TGA associated ventricular septal defect was closed or pulmonary artery stenosis released.
Sixteen (9.5%) patients died at an interval of 2 months to 20 years (median 13 years) postoperatively. A total of 152 patients had detailed clinical and echocardiographic examination, 24-hour Holter ECG monitoring and exercise tests at interval of 5 to 20 years (median 13 years) and at age of 5 to 24 years (median 14 years) after surgery.
Results: Eleven (31.4%) out of 35 patients with complex transposition but only 5 (3.8%) out of 133 patients with isolated TGA died; p < 0.0001. The actuarial survival at 5, 10 and 15 year was 98%, 97% a 97% in patients with simple TGA and 80%, 80% a 71% in patients with complex TGA (p < 0.001).
Late death was caused by the right (systemic) ventricular failure and tricuspid valve regurgitation in 7 (4.2%) patients with complex TGA. Sudden death occurred in 3 (1.7%) patients with a good hemodynamic findings most likely due to severe dysrrhythmia.
Out of 152 patients echocardiography revealed good tricuspid valve function or trivial regurgitation (grade 0-1) in 109 (71.7%) patients, mild (grade 2) regurgitation in 33 (21.7%) and moderate regurgitation (grade 3) in 7 (4.6%) patients, in remaining 3 (2.0%) patients with severe regurgitation the valve was replaced by mechanical prosthesis. The right (systemic) ventricular function was good in 124 (81.6%) patients and mildly or moderately depressed in 24 (15.8%) and 4 (2.6%) patients respectively.
The severe right ventricular dysfunction was not observed in any patient. Overall clinically significant dysrrhythmias were observed in 12 (7.9%) patients.
Nine patients had pacemaker at the time of study, in 7 for sinus node dysfunction and in 2 for advanced AV block. A cardioverter-defibrilator was used in 1 patient for ventricular tachycardia.
Antiarrhythmic drugs were taken by 5 patients for atrial flutter and by 1 patient for junctional tachycardia. The sinus node dysfunction on Holter monitoring without a specific treatment was observed in 36.8% patients.
The maximal oxygen consumption (VO2max.) at exercise was 35.4 +- 6.6 ml/kg/min. corresponding to -2.4 +- 1.5 standard deviation of age and gender normalized control values. Overall 58% of patients had VO2max. lower than -2.0 SD and 43% of patients did not increase heart rate at maximal exercise above -2.0 SD of control values.
Digoxin and/or ACE inhibitors were administered in 34% of patients; 97% of patients were in class I or II NYHA classifi-cation and 76% of responders reported recreational sport activities. Conclusion: Long-term results of Senning correction for isolated transposition of the great arteries are good.
The incidence of severe tricuspid regurgitation and right ventricular failure is higher in patients with complex transposition.