title: Does a balloon atrial septostomy performed before arterial switch surgery increase adverse neurological outcomes?
abstract: This best evidence topic in congenital cardiac surgery was written according to a structured protocol. The question addressed was whether the use of balloon atrial septostomy (BAS) before the arterial switch surgery for transposition of the great arteries (TGA) improved the final outcome. Altogether more than 251 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The search was further limited to recent articles since the results have improved compared with previous years, due to newer equipment and techniques. This narrowed the search to five papers that have focused on this issue since 2006 when a study of 29 term neonates identified BAS as major risk factor for focal brain injury and reinvigorated the debate of adverse neurological outcome especially in the context of the fact that total correction by the arterial switch procedure is routine in neonates now. Subsequently, a prospective study of 64 newborn infants followed by another study of 26 neonates with TGA, have shown no association between BAS and brain injury. Similarly, in a study of more than 2000 cases of dTGA, no association has been found between BAS and increased risk of clinical stroke either in the neonatal period or in follow-up hospitalizations. On the other hand, another nationwide data analysis of 8681 patients with TGA, has shown increased risk of stroke in patients undergoing BAS but it could only show association and not establish causation of the complication. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated.
authors.affiliation: Department of Cardio-thoracic Surgery, Golden Jubilee Hospital, Glasgow, UK. hdoshi@nhs.net
authors.forename: Harikrishna
authors.initials: H
authors.lastname: Doshi
authors.forename: Premsundar
authors.initials: P
authors.lastname: Venugopal
authors.forename: Kenneth
authors.initials: K
authors.lastname: MacArthur
mesh_terms: D019985:Benchmarking; D001930:Brain Injuries / Q000209:etiology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002404:Catheterization / Q000009:adverse effects*; D019317:Evidence-Based Medicine; D006325:Heart Atria; D006801:Humans; D007231:Infant, Newborn; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000601:surgery*; D016896:Treatment Outcome