Timing of Balloon Atrial Septostomy in Patients with d-TGA and Association with Birth Location and Patient Outcomes

Abstract

Patients with d-looped transposition of the great arteries (d-TGA), especially those without an adequate atrial septal defect, can experience severe hypoxemia and hemodynamic compromise in the neonatal period. This can be mitigated by urgent balloon atrial septostomy (BAS). However, some patients with d-TGA are born at centers without this capability. The aim of this retrospective study of d-TGA patients who had urgent or emergent BAS at our institution between 2010 and 2021 was to evaluate time from birth to BAS for infants born at a tertiary care center as compared to those requiring transport from other institutions and to examine correlation between time to BAS and patient outcomes. Our primary outcome was time from birth to BAS. Secondary outcomes included hospital and ICU length of stay, mortality, and evidence of pulmonary or neurologic abnormalities including pulmonary hypertension, abnormal neuroimaging, or seizures. Of 96 patients, 67 (70%) were born at our institution. The median time to BAS was 4 hours for patients born at our institution vs. 14.1 hours for those born elsewhere (p < .0001). A longer time from birth to BAS was associated with longer ICU (r = 0.21, p = 0.046) and hospital length of stay (r = 0.24, p = 0.02) and increased likelihood of elevated right ventricular pressure on post-operative discharge echocardiogram (p = 0.01). There were no differences in mortality between the groups. Therefore, prenatal planning for patients with known d-TGA should include a delivery plan with access to urgent BAS.

Prenatal Detection of D-TGA and Novel Interventional Program Decrease Time to Balloon Septostomy

“…They additionally found patients who were transferred from an outside hospital required more inotropes, had longer hospital length of stay, and had increased likelihood of elevated right ventricular pressure on discharge echocardiogram. 12 Our study expands on this nding and demonstrates that having an interventional team travel to a nearby delivery center is a safe model and effective in reducing time to BAS. There were no procedural complications, and the short-term neurologic complications rate was not signi cantly different between all groups examined.…”

Live-Birth Incidence of Isolated D-Transposition of Great Arteries—The Shift in Trends Due to Early Diagnosis

“…We must highlight that TGA cases (such as tetralogy of Fallot, pulmonary atresia, interrupted aortic arch, coarctation of aorta, and anomalous pulmonary venous return) can be repaired in a biventricular manner. Improvements in management, BAS [ 73 ], and ASO procedures have dramatically altered the outcomes for TGA neonates. Currently, the 25-year postoperative survival rate after arterial switch surpasses 96% [ 74 ].…”

Live-Birth Incidence of Isolated D-Transposition of Great Arteries – the Shifted Trend Due to Early Diagnosis

“…We must highlight that TGA (as tetralogy of Fallot, pulmonary atresia, interrupted aortic arch, coarctation of aorta, and anomalous pulmonary venous return) can be repaired in a biventricle manner. The improvements in management, the BAS [71] and the ASO procedures have altered dramatically outcomes for TGA neonates. Currently, the 25-year postoperative survival rate after arterial switch surpasses 96% [72].…”