Prevalence and Outcomes of Balloon Atrial Septostomy in Neonates With Transposition of Great Arteries

Abstract

Objectives: Transposition of the great arteries is the most common cyanotic congenital heart defect. Surgical correction usually occurs in the first week of life; presence of restrictive interatrial communication and severe hypoxemia warrants urgent intervention with balloon atrial septostomy and medical stabilization prior to surgery. The main objective of this study is to compare the characteristics, outcomes, and mortality risks in patients with transposition of the great arteries who underwent balloon atrial septostomy during their hospitalization versus transposition of the great arteries patients who have not undergone this procedure. Design: Retrospective analysis of administrative data. Setting: Data from Kids’ Inpatient Database complemented with the National Inpatient Sample dataset for the years 1998–2014, this includes data from participating hospitals in 47 U.S. States and the District of Columbia. Patients: Neonates admitted with transposition of the great arteries. Interventions: None. Measurements and Main Results: A total of 17,392 neonates with diagnosis of transposition of the great arteries were captured in the databases we used. Male-to-female ratio was 2:1. The rate of balloon atrial septostomy in patients with transposition of the great arteries was 27.7% without significant change over the years. There was no significant difference in mortality between balloon atrial septostomy and no balloon atrial septostomy (6.3% vs 6.7%; p = 0.29). Neonates with balloon atrial septostomy had a two-fold increase in their length of stay compared with no balloon atrial septostomy (16 d vs 7 d; p < 0.0001). Stroke was present in 1.1% of balloon atrial septostomy group versus 0.6% in those who did not have balloon atrial septostomy (odds ratio, 1.85; 95% CI, 1.29–2.65; p < 0.0001). Extracorporeal membrane oxygenation was used more in balloon atrial septostomy group (5.1% vs 3.1%; p < 0.0001). Conclusions: There was no difference in mortality rate between balloon atrial septostomy and no balloon atrial septostomy patients. The prevalence of the diagnosis of stroke in this study was higher in patients who underwent balloon atrial septostomy. Furthermore, comparison of in-hospital mortality in balloon atrial septostomy and no balloon atrial septostomy revealed increased mortality risk in no balloon atrial septostomy patients transferred from other institution, no balloon atrial septostomy patients supported with extracorporeal membrane oxygenation, and balloon atrial septostomy patients diagnosed with stroke. Finally, length of stay and charges were higher in balloon atrial septostomy patients.

Prenatal sonography of the foramen ovale predicts urgent balloon atrial septostomy in neonates with complete transposition of the great arteries

“…Albeit the definition varies in different studies, the need for an urgent BAS in these cases is in the range of 30% without significant change over the years. 6 Therefore, this maneuver should be readily available in each case. However, there is a consensus that identification of infants at the greatest risk is helpful for the management.…”

Delivery Room Intensive Care Unit: 5 Years' Experience in Assistance of High-Risk Newborns at a Referral Center

“…Deaths occurred in the subsequent clinical course and were not directly related to perinatal assistance. In a recent retrospective analysis, the mortality rate in isolated dTGA after BAS was 6.3% ( 13 ), while we report a 100% survival to discharge. Overall survival in this series of CDH patients was 85% despite the fact that half of the patients had poor prognostic factors (right CDH or left CDH with indication to FETO) or required ECMO after birth.…”

Balloon atrial septostomy for transposition of the great arteries: Safety and experience with the Z‐5 balloon catheter

“…30 The disadvantage of the above-mentioned large national registry studies is the inclusion of the complete postoperative period until discharge and thus no temporal relationship could be established between BAS and stroke. 27,28 In our series, we specifically focused on preoperative brain injury identified clinically or on routine cranial ultrasonography before corrective cardiac surgery. Within our cohort, we also observed a higher prevalence of stroke in patients who underwent BAS compared with those who did not undergo BAS (1.7% vs. 0.9% respectively).…”