Pericardial baffle complications following the Mustard operation. Age- related incidence and ease of management

Pericardial baffle complications with the standard Mustard operation led first to the use of alternative materials of various shapes and finally to the recent popularity of the Senning procedure. At The Oregon Health Sciences University, we have persisted since the mid-1960s in the use of a modified Mustard operation in which a rectangular pericardial baffle is employed. Among 75 patients, there were baffle complications necessitating reoperation in 13. The reoperation-free rates (+/- standard error) at 9 years for patients less than or equal to 6 months, 7 to 12 months, and greater than 12 months of age were 59% +/- 15%, 60% +/- 17%, and 95% +/- 5%, respectively. All 10 patients reoperated upon during the past decade survived with complete relief of symptoms. A double patch to widen both the superior portion of the baffle and the superior vena cava was used most commonly and is our current procedure-of-choice. Baffle complications after the use of pericardium can be managed easily and reoperation on these patients carries a low risk. However, even with experience, the incidence of reoperation remains high in patients under 1 year of age and prompts a critical age-related comparison of these late results with the Senning procedure.