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


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.
Mukherjee
Debraj
D
Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Lindsay
Mark
M
Zhang
Yiyi
Y
Lardaro
Thomas
T
Osen
Hayley
H
Chang
David C
DC
Brenner
Joel I
JI
Abdullah
Fizan
F
D054087:Atrial Septum / Q000601:surgery; D002404:Catheterization; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014188:Transposition of Great Vessels / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States