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

Published online by Cambridge University Press:  17 May 2010

Debraj Mukherjee ,
Mark Lindsay ,
Yiyi Zhang ,
Thomas Lardaro ,
Hayley Osen ,
David C. Chang ,
Joel I. Brenner  and
Fizan Abdullah
Debraj Mukherjee
Affiliation:
Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Mark Lindsay
Affiliation:
Division of Pediatric Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Yiyi Zhang
Affiliation:
Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland, United States of America
Thomas Lardaro
Affiliation:
Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Hayley Osen
Affiliation:
Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
David C. Chang
Affiliation:
Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Joel I. Brenner
Affiliation:
Division of Pediatric Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Fizan Abdullah*
Affiliation:
Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
*
Correspondence to: Dr F. Abdullah, MD, PhD, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Harvey 319; Baltimore, 21287 0005, United States of America. Tel: +410 955 1983; Fax: +410 502 5314; E-mail: fa@jhmi.edu
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Abstract

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.

Methods and 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.

Keywords

Great vesselsneonatesnecrotising enterolitisstroke
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 4 , August 2010 , pp. 373 - 380
Copyright
Copyright © Cambridge University Press 2010

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