title: Long-distance transport of neonates with transposition of the great arteries for the arterial switch operation: A 26-year Western Australian experience.
abstract: OBJECTIVE
  There is evidence that outcomes of complex paediatric cardiac procedures including the arterial switch operation (ASO) for transposition of the great arteries (TGA) are improved when performed at higher volume centres. While in utero transport for surgery is considered ideal, antenatal detection rates of TGA are low. Long-distance transport of post-natally diagnosed neonates has the potential to destabilise the patient's clinical condition. Since 1986, many neonates with TGA have been transported interstate from Perth to Melbourne or Brisbane for ASO surgery. The aim of this study was to review the Western Australian experience of interstate transport of newborns with TGA for ASO, noting transport complications and comparing the early mortality of these patients with published outcomes of the ASO from Royal Children's Hospital (RCH), Melbourne.
  
  
  METHODS
  In this retrospective cohort study, we reviewed the neonatal and cardiology databases and medical records to identify infants with TGA born between 1986 and 2011 and requiring ASO surgery during the neonatal period.
  
  
  RESULTS
  Over 26 years, 80 neonates were transferred interstate for ASO surgery. Twelve infants required ventilation, 36 needed prostaglandin (prostaglandin E1) infusion and 3 inotropic support. There was no mortality during transport and there was a single early post-operative death. This early mortality of 1.2% compares favourably with the RCH mortality of 2.8% from a recently published review of early outcomes for ASO.
  
  
  CONCLUSIONS
  When in utero transport is not possible, long-distance transport of neonates with TGA can be safely undertaken, with no evidence of increased transport mortality/ major morbidity or higher early surgical mortality.
authors.affiliation: Neonatology Clinical Care Unit, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
authors.forename: Saritha
authors.initials: S
authors.lastname: Paul
authors.affiliation: Neonatology Clinical Care Unit, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.|Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia.|Newborn Emergency Transport Service, Perth, Western Australia, Australia.
authors.forename: Steven
authors.initials: S
authors.lastname: Resnick
authors.affiliation: Neonatology Clinical Care Unit, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
authors.forename: Katharine
authors.initials: K
authors.lastname: Gardiner
authors.affiliation: Children's Cardiac Centre, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.|School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: James M
authors.initials: JM
authors.lastname: Ramsay
mesh_terms: D000069278:Arterial Switch Operation / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010360:Patient Transfer / Q000379:methods / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D012189:Retrospective Studies; D014187:Transportation of Patients; D014188:Transposition of Great Vessels / Q000601:surgery*; D016896:Treatment Outcome; D014904:Western Australia
keywords: arterial switch operation; neonatal transport; transposition of great arteries