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

Published online by Cambridge University Press:  17 May 2010

Debraj Mukherjee ,
Mark Lindsay ,
Yiyi Zhang ,
Thomas Lardaro ,
Hayley Osen ,
David C. Chang ,
Joel I. Brenner  and
Fizan Abdullah
Debraj Mukherjee
Affiliation:
Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Mark Lindsay
Affiliation:
Division of Pediatric Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Yiyi Zhang
Affiliation:
Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland, United States of America
Thomas Lardaro
Affiliation:
Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Hayley Osen
Affiliation:
Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
David C. Chang
Affiliation:
Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Joel I. Brenner
Affiliation:
Division of Pediatric Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Fizan Abdullah*
Affiliation:
Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
*
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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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.

Keywords

Great vesselsneonatesnecrotising enterolitisstroke
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 4 , August 2010 , pp. 373 - 380
Copyright
Copyright © Cambridge University Press 2010

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References

1. Warnes, CA. Transposition of the great arteries. Circulation 2006; 114: 2699–2709.CrossRefGoogle ScholarPubMed
2. Sommer, RJ, Hijazi, ZM, Rhodes, JF. Pathophysiology of congenital heart disease in the adult: part III: complex congenital heart disease. Circulation 2008; 117: 1340–1350.CrossRefGoogle ScholarPubMed
3. Gutgesell, HP, Garson, A, McNamara, DG. Prognosis for the newborn with transposition of the great arteries. Am J Cardiol 1979; 44: 96–100.CrossRefGoogle ScholarPubMed
4. Gomelsky, A, Holden, EW, Ellerbeck, KA, Brenner, JI. Predictors of developmental outcomes in children with complete transposition. Cardiol Young 1998; 8: 352–357.CrossRefGoogle ScholarPubMed
5. Ellerbeck, KA, Smith, ML, Holden, EW, et al. Neurodevelopmental outcomes in children surviving d-transposition of the great arteries. J Dev Behav Pediatr 1998; 19: 335–341.CrossRefGoogle ScholarPubMed
6. Ochsner, JL, Cooley, DA, Harris, LC, McNamara, DG. Treatment of complete transposition of the great vessels with the Blalock-Hanlon operation. Circulation 1961; 24: 51–54.CrossRefGoogle ScholarPubMed
7. Pasquali, SK, Hasselblad, V, Li, JS, Kong, DF, Sanders, SP. Coronary artery pattern and outcome of arterial switch operation for transposition of the great arteries: a meta-analysis. Circulation 2002; 106: 2575–2580.CrossRefGoogle ScholarPubMed
8. Reddy, V, Sharma, S, Cobanoglu, A. Atrial switch (senning procedure) in the era of the arterial switch operation: current indications and results. Eur J Cardiothorac Surg 1996; 10: 546–550.CrossRefGoogle Scholar
9. Sarris, GE, Chatzis, AC, Giannopoulos, NM, et al. European congenital heart surgeons association. The arterial switch operation in Europe for transposition of the great arteries: a multi-institutional study from the European congenital heart surgeons association. J Thorac Cardiovasc Surg 2006; 132: 633–639.CrossRefGoogle ScholarPubMed
10. Rashkind, WJ, Miller, WW. Transposition of the great arteries. Results of palliation by balloon atrioseptostomy in thirty-one infants. Circulation 1968; 38: 453–462.CrossRefGoogle ScholarPubMed
11. Baker, F, Baker, L, Zoltun, R, Zuberbuhler, JR. Effectiveness of the Rashkind procedure in transposition of the great arteries in infants. Circulation 1971; 43: I1–I6.CrossRefGoogle ScholarPubMed
12. Rohmer, J. The Rashkind procedure in the treatment of complete transposition of the great vessels. Radiol Clin Biol 1970; 39: 136–139.Google ScholarPubMed
13. Waldhausen, JA, Boruchow, I, Miller, WW, Rashkind, WJ. Transposition of the great arteries with ventricular septal defect. Palliation by atrial septostomy and pulmonary artery banding. Circulation 1969; 39: I215–I221.CrossRefGoogle ScholarPubMed
14. Parsons, CG, Astley, R, Burrows, FG, Singh, SP. Transposition of great arteries. A study of 65 infants followed for 1 to 4 years after balloon septostomy. Br Heart J 1971; 33: 725–731.CrossRefGoogle ScholarPubMed
15. Mok, Q, Darvell, F, Mattos, S, et al. Survival after balloon atrial septostomy for complete transposition of great arteries. Arch Dis Child 1987; 62: 549–553.CrossRefGoogle ScholarPubMed
16. Singh, SP, Astley, R, Burrows, FG. Balloon septostomy for transposition of the great arteries. Br Heart J 1969; 31: 722–726.CrossRefGoogle ScholarPubMed
17. Blanchard, WB, Knauf, DG, Victorica, BE. Interatrial groove tear: an unusual complication of balloon atrial septostomy. Pediatr Cardiol 1983; 4: 149–150.CrossRefGoogle ScholarPubMed
18. Cheng, TO. That balloon atrial septostomy is associated with preoperative stroke in neonates with transposition of the great arteries is another powerful argument in favor of therapeutic closure of every patent foramen ovale. Am J Cardiol 2006; 98: 277–278.CrossRefGoogle ScholarPubMed
19. Crosson, J, Ringel, RE, Haney, PJ, Brenner, JI. Pneumopericardium as a complication of balloon atrial septostomy. Pediatr Cardiol 1987; 8: 135–137.CrossRefGoogle ScholarPubMed
20. Finan, E, Mak, W, Bismilla, Z, McNamara, PJ. Early discontinuation of intravenous prostaglandin E(1) after balloon atrial septostomy is associated with an increased risk of rebound hypoxemia. J Perinatol 2008; 28: 341–346.CrossRefGoogle Scholar
21. Henry, CG, Goldring, D, Hartmann, AF, Weldon, CS, Strauss, AW. Treatment of d-transposition of the great arteries: management of hypoxemia after balloon atrial septostomy. Am J Cardiol 1981; 47: 299–306.CrossRefGoogle ScholarPubMed
22. McQuillen, PS, Hamrick, SE, Perez, MJ, et al. Balloon atrial septostomy is associated with preoperative stroke in neonates with transposition of the great arteries. Circulation 2006; 113: 280–285.CrossRefGoogle ScholarPubMed
23. McQuillen, PS, Barkovich, AJ, Hamrick, SE, et al. Temporal and anatomic risk profile of brain injury with neonatal repair of congenital heart defects. Stroke 2007; 38: 736–741.CrossRefGoogle ScholarPubMed
24. Sondheimer, HM, Kavey, RE, Blackman, MS. Fatal over-distention of an atrioseptostomy catheter. Pediatr Cardiol 1982; 2: 255–257.CrossRefGoogle ScholarPubMed
25. Turley, K, Ebert, PA. Transposition of the great arteries in the neonate: failed balloon atrial septostomy. J Cardiovasc Surg (Torino) 1985; 26: 564–567.Google ScholarPubMed
26.Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP). Internet 20 March, 2008; http://www.hcup-us.ahrq.gov.Google Scholar
27.Agency for Healthcare Research and Quality. Overview of the National Inpatient Sample. Internet 10 August, 2008; http://www.hcup-us.ahrq.gov/nisoverview.jsp.Google Scholar
28.Agency for Healthcare Research and Quality. Overview of the Kids’ Inpatient Database. Internet 10 January, 2008; www.hcup-us.ahrq.gov/kidoverview.jsp.Google Scholar
29.Federal Reserve Bank of Minneapolis. Consumer Price Index, 1913. Internet 2 April, 2008; http://www.minneapolisfed.org/research/data/us/calc/hist1913.cfm.Google Scholar
30. McElhinney, DB, Hedrick, HL, Bush, DM, et al. Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 2000; 106: 1080–1087.CrossRefGoogle Scholar
31. Giannone, PJ, Luce, WA, Nankervis, CA, Hoffman, TM, Wold, LE. Necrotizing enterocolitis in neonates with congenital heart disease. Life Sci 2008; 82: 341–347.CrossRefGoogle ScholarPubMed
32. Dees, E, Lin, H, Cotton, RB, Graham, TP, Dodd, DA. Outcome of preterm infants with congenital heart disease. J Pediatr 2000; 137: 653–659.CrossRefGoogle ScholarPubMed
33. Lambert, DK, Christensen, RD, Henry, E, et al. Necrotizing enterocolitis in term neonates: data from a multihospital health-care system. J Perinatol 2007; 27: 437–443.CrossRefGoogle ScholarPubMed
34. Hasegawa, T, Yoshioka, Y, Sasaki, T, et al. Necrotizing enterocolitis in a term infant with coarctation of the aorta complex. Pediatr Surg Int 1997; 12: 57–58.CrossRefGoogle Scholar
35. Stapleton, GE, Eble, BK, Dickerson, HA, Andropoulos, DB, Chang, AC. Mesenteric oxygen desaturation in an infant with congenital heart disease and necrotizing enterocolitis. Tex Heart Inst J 2007; 34: 442–444.Google Scholar