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Elective Non-Urgent Balloon-Atrial Septostomy in Infants with d-Transposition of the Great Arteries Does Not Eliminate the Need for PGE1 Therapy at the Time of Arterial Switch Operation

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Abstract

Once a mainstay in the treatment of neonates with d-transposition of the great arteries (d-TGA), the application of balloon atrial septostomy (BAS) in the d-TGA population has become more selective. Currently, there is no clear evidence for or against a selective BAS strategy. The aims of this single-center retrospective study were to determine the incidence of BAS in the neonatal d-TGA population in the current era, to measure the rate of procedural success, and to compare the outcomes and complication rates of patients who underwent BAS to those who underwent neonatal ASO alone. Between 2012 and 2018, 147 patients with d-TGA underwent initial medical management and ASO, 73 of which underwent BAS. The percentage of patients that underwent BAS decreased from 73 to 33% over the study time period. In patients with d-TGA with intact ventricular septum, 33% of patients remained off of PGE1 at the time of surgery regardless of BAS. In d-TGA with ventricular septal defect, 85.7% of those that underwent BAS and 54.1% of those who did not remained off of PGE1 at the time of surgery, however, this difference did not reach statistical significance. In this single institution retrospective cohort of patients with d-TGA, the performance of a technically successful balloon atrial septostomy did not eliminate the need for PGE1 therapy at the time of definitive ASO. This was true regardless of the presence or absence of a ventricular septal defect.

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Authors and Affiliations

  1. Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA

    Katherine L. Zaleski, Steven J. Staffa, James A. DiNardo & Viviane G. Nasr

  2. Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA, USA

    Carl L. McMullen

  3. Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA

    Ravi R. Thiagarajan & Nicola Maschietto

Authors
  1. Katherine L. Zaleski
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  2. Carl L. McMullen
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  3. Steven J. Staffa
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  4. Ravi R. Thiagarajan
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  5. Nicola Maschietto
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  6. James A. DiNardo
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  7. Viviane G. Nasr
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Contributions

KLZ Contributed to the acquisition and analysis of data as well as the composition of the final manuscript. CM Contributed to the acquisition of data. SJS Contributed to the analysis of data as well as the composition of the final manuscript. RRT Contributed to the analysis of data as well as the composition of the final manuscript. JAD Contributed to the analysis of data as well as the composition of the final manuscript. VGN Contributed to the acquisition and analysis of data as well as the composition of the final manuscript.

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Correspondence to Katherine L. Zaleski.

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This study was approved by the Boston Children’s Hospital Institutional Review Board.

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Zaleski, K.L., McMullen, C.L., Staffa, S.J. et al. Elective Non-Urgent Balloon-Atrial Septostomy in Infants with d-Transposition of the Great Arteries Does Not Eliminate the Need for PGE1 Therapy at the Time of Arterial Switch Operation. Pediatr Cardiol 42, 597–605 (2021). https://doi.org/10.1007/s00246-020-02520-x

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  • DOI: https://doi.org/10.1007/s00246-020-02520-x

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