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No difference found in safety or efficacy of balloon atrial septostomy performed at the bedside versus the catheterisation laboratory

Published online by Cambridge University Press:  28 August 2018

Fabio Savorgnan ,
Nicholas B. Zaban ,
Justin J. Elhoff ,
Michael M. Ross  and
John P. Breinholt
Fabio Savorgnan*
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Nicholas B. Zaban
Affiliation:
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
Justin J. Elhoff
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Michael M. Ross
Affiliation:
Department of Pediatrics, University of Colorado, Aurora, CO, USA
John P. Breinholt
Affiliation:
Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, USA
*
Author for correspondence: F. Savorgnan, MD, Texas Children’s Hospital, 6621 Fannin Street, Suite W6006, Houston, TX 77030, USA. Tel: +716 548 4116; FAX: 832 825 6229; E-mail: fxsavorg@texaschildrens.org
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Abstract

Background

Balloon atrial septostomy is performed in infants with dextro-transposition of the great arteries to improve oxygenation before surgery. It is performed in the catheterisation laboratory with fluoroscopy or at the bedside using echocardiography. It is unclear whether procedural safety and efficacy is superior in one location versus the other, although the bedside procedure may improve resource utilisation and present an opportunity for reducing cost. This study compares safety and efficacy of atrial septostomy performed at the patient’s bedside versus the catheterisation laboratory.

Methods

Neonates with dextro-transposition of the great arteries who underwent balloon atrial septostomy from October, 2000 to January, 2014 were included. Medical and procedural records, echocardiograms, and catheterisation data were reviewed. Comparisons between the two procedural locations included patient demographics, pre- and post-procedure oxygen saturations, and outcomes. Complications reviewed included bleeding, arrhythmia, cardiac trauma, stroke, and death. Coronary artery evaluations were recorded. T-tests were used for continuous variables, and Fisher’s exact tests were used for all categorical variables. Wilcoxon rank sum and analysis of covariance modelling were used for time variables and oxygen saturation, respectively.

Results

A total of 88 infants met the inclusion criteria. Among them, 53 underwent septostomy at the bedside and 35 underwent septostomy in the catheterisation laboratory. No safety or outcome benefit was identified between the two procedural locations.

Conclusion

Septostomy performed at the bedside and in the catheterisation laboratory had similar outcomes and efficacy. Further, bedside septostomy has the advantage of no radiation exposure, and obviating risks with patient transfer from the ICU to the catheterisation laboratory.

Keywords

Balloon atrial septostomydextro-transposition of the great arteriescatheterisation laboratorybedside procedurecost-effectiveness
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 12 , December 2018 , pp. 1421 - 1425
Copyright
© Cambridge University Press 2018 

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References

1. Vigneswaran, TV, Zidere, V, Miller, OI, Simpson, JM, Sharland, GK. Usefulness of the prenatal echocardiogram in fetuses with isolated transposition of the great arteries to predict the need for balloon atrial septostomy. Am J Cardiol 2017; 119: 1463–1467.Google Scholar
2. Zellers, TM, Dixon, K, Moake, L, Wright, J, Ramaciotti, C. Bedside balloon atrial septostomy is safe, efficacious, and cost-effective compared with septostomy performed in the cardiac catheterization laboratory. Am J Cardiol 2002; 89: 613–615.Google Scholar
3. Hiremath, G, Natarajan, G, Math, D, Aggarwal, S. Impact of balloon atrial septostomy in neonates with transposition of great arteries. J Perinatol 2011; 31: 494–499.Google Scholar
4. Van der Laan, ME, Verhagen, EA, Bos, AF, Berger, RM, Kooi, EM. Effect of balloon atrial septostomy on cerebral oxygenation in neonates with transposition of the great arteries. Pediatr Res 2013; 73: 62–67.Google Scholar
5. Bullaboy, CA, Jennings, RB Jr, Johnson, DH. Bedside balloon atrial septostomy using echocardiographic monitoring. Am J Cardiol 1984; 53: 971.Google Scholar
6. Baker, EJ, Allan, LD, Tynan, MJ, Jones, OD, Joseph, MC, Deverall, PB. Balloon atrial septostomy in the neonatal intensive care unit. Br Heart J 1984; 51: 377–378.Google Scholar
7. Steeg, CN, Bierman, FZ, Hordof, AJ, Hayes, CJ, Krongrad, E, Barst, RJ. Bedside balloon septostomy in infants with transposition of the great arteries: new concepts using two-dimensional echocardiographic techniques. J Pediatr 1985; 107: 944–946.Google Scholar
8. D’Orsogna, L, Lam, J, Sandor, GG, Patterson, MW. Assessment of bedside umbilical vein balloon septostomy using two-dimensional echocardiographic guidance in transposition of great arteries. Int J Cardiol 1989; 25: 271–277.Google Scholar
9. Lin, AE, Di Sessa, TG, Williams, RG. Balloon and blade atrial septostomy facilitated by two-dimensional echocardiography. Am J Cardiol 1986; 57: 273–277.Google Scholar
10. Martin, AC, Rigby, ML, Penny, DJ, Redington, AN. Bedside balloon atrial septostomy on neonatal units. Arch Dis Child Fetal Neonatal Ed 2003; 88: F339–F340.Google Scholar
11. Verheij, G, Smits-Wintjens, V, Rozendaal, L, Blom, N, Walther, F, Lopriore, E. Cardiac arrhythmias associated with umbilical venous catheterisation in neonates. BMJ Case Rep 2009. [Published online 21 June, 2009].Google Scholar
12. Green, C, Yohannan, MD. Umbilical arterial and venous catheters: placement, use, and complications. Neonatal Netw 1998; 17: 23–28.Google Scholar
13. Mukherjee, D, Lindsay, M, Zhang, Y, et al. Analysis of 8681 neonates with transposition of the great arteries: outcomes with and without Rashkind balloon atrial septostomy. Cardiol Young 2010; 20: 373–380.Google Scholar
14. Polito, A, Ricci, Z, Fragasso, T, Cogo, PE. Balloon atrial septostomy and pre-operative brain injury in neonates with transposition of the great arteries: a systematic review and a meta-analysis. Cardiol Young 2012; 22: 1–7.Google Scholar
15. Pasquali, SK, Hasselblad, V, Li, JS, Kong, DF, Sanders, SP. Coronary artery pattern and outcome of arterial switch operation for transposition of the great arteries: a meta-analysis. Circulation 2002; 106: 2575–2580.Google Scholar
16. Qamar, ZA, Goldberg, CS, Devaney, EJ, Bove, EL, Ohye, RG. Current risk factors and outcomes for the arterial switch operation. Ann Thorac Surg 2007; 84: 871–878.Google Scholar
17. Sarris, GE, Chatzis, AC, Giannopoulos, NM, et al. The arterial switch operation in Europe for transposition of the great arteries: a multi-institutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg 2006; 132: 633–639.Google Scholar
18. Brown, JW, Park, HJ, Turrentine, MW. Arterial switch operation: factors impacting survival in the current era. Ann Thorac Surg 2001; 71: 1978–1984.Google Scholar
19. Hong, SJ, Choi, HJ, Kim, YH, Hyun, MC, Lee, SB, Cho, JY. Clinical features and surgical outcomes of complete transposition of the great arteries. Korean J Pediatr 2012; 55: 377–382.Google Scholar