Transposition of the great arteries: A comparison of results of the Mustard procedure versus the arterial switch

Sixty infants with transposition of the great arteries and intact ventricular septum underwent primary surgical correction in the first 3 months of life. Twenty-three patients had a Mustard procedure (group 1) and 37 patients, an arterial switch operation (group 2). The mean age at the time of repair was 42 ± 31 days for group 1 and 8 ± 6 days for group 2 (p < 0.001). The mean weight at the time of repair was 3.6 ± 0.7 kg for group 1 and 3.4 ± 0.5 kg for group 2 (p = not significant). Operative mortality was 8.7% ( 2 23) in group 1 and 8.1% ( 3 37) in group 2 (p = not significant). The incidence of arrhythmias in the early postoperative period was 39% ( 9 23) in group 1 and 11% ( 4 37) in group 2 (p < 0.01). All patients were followed a mean of 4.8 ± 2.4 years in group 1 and 2.6 ± 1.4 years in group 2 (p < 0.001). Postoperative catheterization has been performed in 86% ( 18 21) of group 1 operative survivors and 50% ( 17 34) of group 2 operative survivors. Ejection fraction of the systemic ventricle was 79% ± 15% of predicted normal in group 1 and 98% ± 6% in group 2 (p < 0.005). The incidence of late arrhythmias was 57% ( 12 21) in group 1 and 3% ( 1 34) in group 2 (p < 0.001). There have been 2 late deaths in group 1 and 1 late death in group 2 (p = not significant). The data suggest that the arterial switch operation has early and late mortality comparable with those of the Mustard operation but is superior in terms of significantly fewer arrhythmias and preservation of ventricular function, thus making it the procedure of choice for infants with transposition of the great arteries.