Prenatal diagnosis, hospital characteristics, and mortality in transposition of the great arteries.
BACKGROUND
The role of prenatal diagnosis in reducing neonatal mortality from transposition of the great arteries (TGA) is controversial. Factors affected by prenatal diagnosis such as proximity at birth to a cardiac surgical center (CSC) and CSC volume are associated with mortality in congenital heart disease. The purpose of the study was to determine the associations between prenatal diagnosis, distance from birthplace to a CSC, CSC TGA volume, and neonatal mortality in patients with TGA.


METHODS
The Texas Birth Defects Registry was queried for all live born infants with TGA from 1999 to 2007. Four hundred sixty-eight cases of TGA were included.


RESULTS
Forty-eight patients (10.3%) were prenatally diagnosed, and 20 patients died before age 28 days (4.3%). Neither prenatal diagnosis nor close proximity to a CSC at birth (p > 0.05) were associated with decreased mortality. Low CSC TGA volume was associated with increased mortality (p < 0.0002). Mortality at the CSCs with <5 patients per year was 9.6%; CSCs with 5 to 10 patients per year had 0% mortality, and those with >10 patients per year had 2.3% mortality. In multivariable logistic regression, only preterm birth (odds ratio, 7.05; 95% confidence interval, 4.13-12.05) and lower CSC volume (p < 0.001) were associated with neonatal mortality, although prenatal diagnosis attenuated the detrimental association of lower volume CSCs with higher mortality (p for interaction = 0.047).


CONCLUSIONS
Lower CSC TGA patient volume was associated with higher neonatal mortality. Prenatal diagnosis may improve survival in lower volume CSCs. Birth Defects Research (Part A) 106:739-748, 2016. © 2016 Wiley Periodicals, Inc.
Department of Pediatrics, Baylor College of Medicine, Houston, Texas. dalara@bcm.edu.
Diego A
DA
Lara
Department of Pediatrics, UT Southwestern Medical School, Dallas, Texas.
David E
DE
Fixler
Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas.
Mary K
MK
Ethen
Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas.
Mark A
MA
Canfield
Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital Research Institute, Little Rock, Arkansas.
Wendy N
WN
Nembhard
Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Shaine A
SA
Morris
D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D011296:Prenatal Diagnosis; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000503:physiopathology
arterial switch operation; congenital heart disease; hospital volume; mortality; prenatal diagnosis; surgical outcomes; transposition of the great arteries