Revival and Modification of the Mustard Operation

Abstract Objective The neonatal arterial switch operation (ASO) is currently the procedure of choice for patients with TGA. However, a large number of patients, present too late for ASO and are best managed with atrial switch. Methods We have used the Mustard operation in its original form or following a new modification designed to enhance the atrial functions and filling of the LV, in an attempt to improve long-term results. Results Between July 2013 and November 2018, a total of 101 patients underwent the Mustard operation, 86 with the new modification. The median age at operation was 16 months (6 months - 27 years). 75 patients (74.3%) were males. Median preoperative oxygen saturation was 71%. There were no early deaths, and 3 late deaths during a median follow-up period of 24.2 months (all in patients with large VSD and established pulmonary vascular disease). At latest follow up, all patients were in stable sinus rhythm. There were no baffle leaks. 7 patients had asymptomatic narrowing of the superior baffle, one required balloon dilatation. Follow-up is 100% complete and includes CT and MRI at regular intervals (75 patients to date). Computerised analysis of representative subsets, showed enhanced rate and pattern of filling of the LV in the modified operation compared to the classic operation. Conclusion The use of 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 LV could enhance the long-term results of the Mustard operation.