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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
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

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2010

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References

1. Warnes, CA. Transposition of the great arteries. Circulation 2006; 114: 26992709.Google Scholar
2. Sommer, RJ, Hijazi, ZM, Rhodes, JF. Pathophysiology of congenital heart disease in the adult: part III: complex congenital heart disease. Circulation 2008; 117: 13401350.Google Scholar
3. Gutgesell, HP, Garson, A, McNamara, DG. Prognosis for the newborn with transposition of the great arteries. Am J Cardiol 1979; 44: 96100.Google Scholar
4. Gomelsky, A, Holden, EW, Ellerbeck, KA, Brenner, JI. Predictors of developmental outcomes in children with complete transposition. Cardiol Young 1998; 8: 352357.Google Scholar
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: 335341.Google Scholar
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: 5154.Google Scholar
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: 25752580.Google Scholar
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: 546550.Google 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: 633639.Google Scholar
10. Rashkind, WJ, Miller, WW. Transposition of the great arteries. Results of palliation by balloon atrioseptostomy in thirty-one infants. Circulation 1968; 38: 453462.Google Scholar
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: I1I6.Google Scholar
12. Rohmer, J. The Rashkind procedure in the treatment of complete transposition of the great vessels. Radiol Clin Biol 1970; 39: 136139.Google Scholar
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: I215I221.Google Scholar
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: 725731.Google Scholar
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: 549553.Google Scholar
16. Singh, SP, Astley, R, Burrows, FG. Balloon septostomy for transposition of the great arteries. Br Heart J 1969; 31: 722726.Google Scholar
17. Blanchard, WB, Knauf, DG, Victorica, BE. Interatrial groove tear: an unusual complication of balloon atrial septostomy. Pediatr Cardiol 1983; 4: 149150.Google Scholar
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: 277278.Google Scholar
19. Crosson, J, Ringel, RE, Haney, PJ, Brenner, JI. Pneumopericardium as a complication of balloon atrial septostomy. Pediatr Cardiol 1987; 8: 135137.Google Scholar
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: 341346.Google 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: 299306.Google Scholar
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: 280285.Google Scholar
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: 736741.Google Scholar
24. Sondheimer, HM, Kavey, RE, Blackman, MS. Fatal over-distention of an atrioseptostomy catheter. Pediatr Cardiol 1982; 2: 255257.Google Scholar
25. Turley, K, Ebert, PA. Transposition of the great arteries in the neonate: failed balloon atrial septostomy. J Cardiovasc Surg (Torino) 1985; 26: 564567.Google Scholar
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: 10801087.Google Scholar
31. Giannone, PJ, Luce, WA, Nankervis, CA, Hoffman, TM, Wold, LE. Necrotizing enterocolitis in neonates with congenital heart disease. Life Sci 2008; 82: 341347.Google Scholar
32. Dees, E, Lin, H, Cotton, RB, Graham, TP, Dodd, DA. Outcome of preterm infants with congenital heart disease. J Pediatr 2000; 137: 653659.Google Scholar
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: 437443.Google Scholar
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: 5758.Google 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: 442444.Google Scholar