Cardiology in the Young

Original Articles

Analysis of 8681 neonates with transposition of the great arteries: outcomes with and without Rashkind balloon atrial septostomy

Debraj Mukherjeea1, Mark Lindsaya2, Yiyi Zhanga3, Thomas Lardaroa1, Hayley Osena1, David C. Changa1, Joel I. Brennera2 and Fizan Abdullaha1 c1

a1 Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America

a2 Division of Pediatric Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America

a3 Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland, United States of America

Abstract

Background Rashkind balloon atrial septostomy is a common cardiac procedure aimed at improving systemic oxygenation in newborns with cyanotic congenital cardiac defects, such as transposition of the great arteries. Recent reports on the safety of this procedure were from limited series at single institutions. We analysed two complementary national databases to evaluate clinically relevant outcomes of this procedure.

Methods and results We performed an analysis of transposition of the great artery patients nationwide using 15 years of the Nationwide In-patient Sample and three complementary years of the Kids’ Inpatient Database. Variables included gender, race, age, and co-existing diagnoses. Outcomes included mortality, length of stay, and hospital charges. Comparison between patients undergoing Rashkind procedure or not was performed using Pearson’s chi-square and Kruskal–Wallis tests. We identified 8681 patients with transposition of the great arteries, of whom 1742 (20%) underwent Rashkind procedure. Patients undergoing Rashkind procedure had lower mortality (10% versus 12%, p = 0.021), despite higher median co-morbidities and longer median length of stay. Rashkind procedure was not associated with increased risk of necrotising enterocolitis (1% versus 1%, p = 0.630), but was associated with nearly twice the risk of clinically recognised stroke (1% versus 0%, p = 0.046).

Conclusions This study represents the largest national analysis of transposition of the great artery patients to date, with a subset treated with Rashkind procedure. Patients not undergoing Rashkind procedure had higher mortality. Rashkind procedure was not associated with increased risk of necrotising enterocolitis, but was associated with twice the risk of stroke.

(Received May 08 2009)

(Accepted November 16 2009)

(Online publication May 17 2010)

Correspondence:

c1 Correspondence to: Dr F. Abdullah, MD, PhD, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Harvey 319; Baltimore, 21287 0005, United States of America. Tel: +410 955 1983; Fax: +410 502 5314; E-mail: fa@jhmi.edu

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