Original article: cardiovascular
Health status, functional abilities, and quality of life after the Mustard or Senning operation

https://doi.org/10.1016/j.athoracsur.2003.09.073Get rights and content

Abstract

Background

Life expectancy of patients who underwent atrial switch operation for the transposition of the great arteries is relatively good. However, many patients are faced with residua and sequelae, which may hamper their functioning and quality of life. This multicenter study assessed the perceived health status, functional abilities, and quality of life in long-term survivors of the Mustard or Senning operation.

Methods

A group of 89 patients (58% male) were selected from four tertiary care centers, consisting of 37 Mustard and 52 Senning operation patients. Perceived health status was measured using a linear analog scale. The educational level, employment status, New York Health Association classification, ability index, and Baecke questionnaire were used to evaluate functional abilities. Quality of life was assessed with a linear analog scale, the Satisfaction with Life Scale, and the Congenital Heart Disease—TNO/AZL Adult Quality of Life.

Results

Patients reported good to very good perceived health, functional capacities, and quality of life. The responses of patients with complex transposition were equivalent to those of patients with simple transposition. The most dominant concerns reported by survivors of the Mustard and Senning operations were experiences about physical limitations and worries about a current or future job or income.

Conclusions

Long-term survivors after atrial inflow correction demonstrated favorable perceived health, functional status, and quality of life; these conditions were, to a large extent, comparable with the status of the general population. These outcome variables were not negatively affected by the complexity of the transposition.

Section snippets

Study population

This study was part of a nationwide, multicenter research project on long-term outcomes (up to 30 years after the Mustard or Senning operation) [5]. The larger study included 339 patients who underwent either a Mustard or Senning operation or received postoperative follow-up in one of six pediatric cardiology centers in Belgium, or both. Patients could be included in this quality of life study if they survived the operation, if they were at least 18 years of age on January 1 2002, if they were

Health status

Perceived health status was measured by using a linear analog scale (LAS). This is a vertical, graded, 10-cm line, ranging from the worst imaginable health state of zero to the best imaginable health state of 100. The LAS is part of the EuroQol instrument and is considered to have good validity and reliability results [13].

Functional abilities

The variables that defined the functional status of the patients included educational level, employment status, New York Heart Association functional class [14], ability

Statistical analysis

The data were analyzed using SPSS 9.0. Nominal level data were expressed in percentages. Medians and quartiles were calculated for continuous, nonnormally distributed variables. The Mann-Whitney U test and χ2 test were used for two-group comparisons of continuous and nominal data. The level of significance was set at p less than or equal to 0.05.

The CHD-TAAQOL was measured at the ordinal level. Therefore, ridit analysis, a sensitive statistical method to analyze ordinal data [21], was chosen. A

Patient characteristics

Eighty-nine patients were included in the study, of which 52 (58%) were male and 37 (42%) were female (Table 1). The median age of the patients was 24 years. This relatively young age implied that most patients were unmarried and living with their parents. Simple d-TGA, without concomitant anomalies or with only minor heart defects, was observed in 76% of the patients. Transposition in the remaining 24% was associated with other cardiac lesions, such as large ventricular septal defects,

Comment

This is the first study that comprehensively assesses health status, functional abilities, and quality of life after a Mustard or Senning operation for simple and complex transposition of the great arteries. Previous studies on quality of life and functional outcome were limited to patients who had undergone a Mustard operation 7, 9 or patients who had had a simple transposition of the great arteries [9]. Moreover, a sound comparison of patients with simple or complex transposition is lacking.

Acknowledgements

This study was supported by the Belgian National Foundation for Research in Pediatric Cardiology.

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