Revival and Modification of the Mustard Operation

Professor Yacoub and his team reported their experience with the use of the Mustard operation, in its original form and in a new modification designed to enhance the atrial functions and filling of the left ventricle.

In 5 years, 101 patients with transposition of the great arteries (TGA) underwent the Mustard operation, 86 with the new modification. The median age at operation was 16 months (6 months - 27 years), 75 patients were male (74.3%), and median preoperative oxygen saturation was 71%. There were no early deaths. Three patients died during a median follow-up of 24.2 months, all with large VSD and established pulmonary vascular disease. At latest follow up, all patients were in stable sinus rhythm. There were no baffle leaks. Seven patients had asymptomatic narrowing of the superior baffle, and one required balloon dilation. The authors report that follow-up is 100% complete and includes CT and MRI at regular intervals (75 patients to date). Analysis of representative subsets showed enhanced rate and pattern of left ventricle filling in the modified operation compared to the classic Mustard operation.

The authors conclude that the Mustard operation, particularly the modified technique, should play an important role in treating late-presenting patients with TGA. Improving the pattern of filling of the left ventricle could enhance the long-term results of the Mustard operation.