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Balloon atrial septostomy performed “out-of-hours”: effects on the outcome

Published online by Cambridge University Press:  04 April 2012

Sunitha Vimalesvaran ,
Salma Ayis  and
Thomas Krasemann
Sunitha Vimalesvaran
Affiliation:
Department of Paediatric Cardiology, Evelina Children's Hospital, Westminster Bridge Road, London, United Kingdom
Salma Ayis
Affiliation:
Department of Primary Care and Public Health Sciences, King's College London, London, United Kingdom
Thomas Krasemann*
Affiliation:
Department of Paediatric Cardiology, Evelina Children's Hospital, Westminster Bridge Road, London, United Kingdom
*
Correspondence to: Dr T. Krasemann, MD FRCP, Department of Paediatric Cardiology, Evelina Children's Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom. Tel: +44 2071884562; Fax: +44 2071884556; E-mail: [email protected]
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Abstract

Background

Balloon atrial septostomy is a common palliative procedure in neonates with cyanotic congenital heart disease with restricted interatrial blood flow. Despite its advantages, balloon atrial septostomy is not a risk-free procedure and can be associated with numerous complications. The objective of this study is to determine whether the performance of this procedure out-of-hours has a significant impact on the incidence of adverse outcome measures.

Methods and Results

A total of 106 neonates who underwent balloon atrial septostomy between 2004 and 2010 were studied retrospectively. In all, 64 infants had the procedure performed within routine hours (9 am to 6 pm), whereas 42 neonates underwent the procedure out-of-hours (6:01 pm to 8:59 am). Procedure-related complications occurred in 32 infants (30.2%), which included 12 out of 64 (18.8%) infants in the routine-hours group and 20 out of 42 (47.6%) in the out-of-hours group. During further follow-up after surgery and including both major and minor adverse events, seven more infants (10.9%) suffered complications after balloon atrial septostomy in the routine-hours group and four more infants (9.5%) suffered complications in the out-of-hours group. This totalled the complication rate in the routine-hours group to 19 infants (29.7%) and 24 infants (57.1%) in the out-of-hours group (p = 0.001). A higher overall mortality rate was also noted in the out-of-hours group.

Conclusions

Balloon atrial septostomy performed out-of-hours produced higher complication rates as opposed to balloon atrial septostomy performed during routine hours. Only essential cases should be undertaken at night, and all other cases should be deferred to the daytime to limit unnecessary adverse complication.

Keywords

Balloon atrial septostomyRashkindcomplications
Type
Original Article
Information
Cardiology in the Young , Volume 23 , Issue 1 , February 2013 , pp. 61 - 67
Copyright
Copyright © Cambridge University Press 2012

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References

1. Mosca, R. Balloon atrial septostomy: let's take a closer look. J Am Coll Cardiol 2009; 53: 1812–1813.Google Scholar
2. McQuillen, PS, Hamrick, SEG, Perez, MJ, et al. Balloon atrial septostomy is associated with preoperative stroke in neonates with transposition of the great arteries. Circulation 2006; 113: 280–285.Google Scholar
3. Campbell B. Interventional Procedure Consultation Document – balloon or blade atrial septostomy in neonates. National Institue for Clinical Excellence. http://www.nice.org.uk/guidance/index.jsp?action=article&o=31075 (accessed 7 February 2011).Google Scholar
4. Bazian Ltd. Interventional procedure overview of balloon or blade atrial septostomy. National Institute for Clinical Excellency (NICE), 2003.Google Scholar
5. Faiz, O, Banerjee, S, Tekkis, P, Papagrigoriadis, S, Rennie, J, Leather, A. We still need to operate at night!. World Journal of Emergency Surgery 2007; 2: 29.CrossRefGoogle ScholarPubMed
6. Ricci, WM, Gallagher, B, Brandt, A, et al. Is after-hours orthopaedic surgery associated with adverse outcomes? The Journal of Bone and Joint Surgery (American) 2009; 91: 2067–2207.CrossRefGoogle ScholarPubMed
7. Yardeni, D, Hirschl, RB, Drongowski, RA, et al. Delayed versus immediate surgery in acute appendicitis: do we need to operate during the night? Journal of Pediatric Surgery 2004; 39: 464–469.CrossRefGoogle ScholarPubMed
8. Rashkind, WJ, Miller, WW. Creation of an atrial septal defect without thoracotomy. JAMA 1966; 196: 991–992.Google Scholar
9. Penny, DJ, Shekerdemian, LS. Management of the neonate with symptomatic congenital heart disease. Arch Dis Child Fetal Neonatal Ed 2001; 84: F141–F145, doi:10.1136/fn.84.3.F141 Google Scholar
10. 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. Cardiology in the Young 2010; 20: 373–380.Google Scholar
11. Baellan, B, Gleason, M. Role of balloon atrial septostomy before early arterial switch repair of transposition of the great arteries. JACC 1992; 19: 1021–1031.Google Scholar
12. McKee, M, Priest, P, Ginzler, M, Black, N. Which general surgical operations must be done at night? Ann R Coll Surg Engl 1991; 73: 295–301.Google Scholar
13. Mulla, Neda F, Osher, Anne P. Scoring system to determine need for balloon atrial septostomy for restrictive interatrial communication in infants with hypoplastic left heart syndrome. J Heart Lung Transplantat. 2003; 22: 883–888.Google Scholar
14. A report by the National Confidential Enquiry into Perioperative Deaths. Who operates when II?; 2003. http://www.ncepod.org.uk (accessed November 2003).Google Scholar
15. Akagi, T, Tananari, Y, Maeno, YV, et al. Torn-off balloon tip of Z-5 atrial septostomy catheter. Catheter Cardiovasc Interv 2001; 52: 500–503.CrossRefGoogle ScholarPubMed
16. Vitiello, R, McCrindle, BW, Nykanen, D, Freedom, RM, Benson, LN. Complications associated with pediatric cardiac catheterization. J Am Coll Cardiol 1998; 32: 1433–1440.Google Scholar
17. Beca, J, Gunn, J. Pre-operative brain injury in newborn infants with transposition of the great arteries occurs at rates similar to other complex congenital heart disease and is not related to balloon atrial septostomy. J Am Coll Cardiol 2009; 53: 1807–1811.Google Scholar
18. Applegate, SE, Lim, DS. Incidence of stroke in patients with d-transposition of the great arteries that undergo balloon atrial septostomy in the University Healthsystem Consortium Clinical Data Base/Resource Manager. Catheter Cardiovasc Interv 2010; 76: 129–131.Google Scholar