The Need for Preoperative Prostaglandin E1 for d-Transposition After Balloon Atrial Septostomy

CJC Pediatric and Congenital Heart Disease Pub Date : 2024-10-01 DOI:10.1016/j.cjcpc.2024.08.004

Thita Pacharapakornpong MD , Linda Edwards MD , Steven Rathgeber MD

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Abstract

Background

The necessity of prostaglandin E1 (PGE) usage before arterial switch operation (ASO) in infants with d-transposition of the great arteries (dTGA) after balloon atrial septostomy (BAS) remains controversial.

Methods

This study is a single-centre, retrospective review of infants with dTGA who underwent ASO from January 2014 to December 2021. Parameters analysed included post-BAS oxygen saturation, time from BAS to PGE discontinuation, necessity of reinitiation, interval before PGE restart, and lowest saturation before PGE reintroduction.

Results

Among the 35 cases of dTGA who underwent ASO, 31 (88%) required BAS, with 23 (65%) requiring PGE infusion. Of those 23 infants, 14 (60%) necessitated PGE reinitiation after discontinuation. A significant difference in post-BAS oxygen saturation was observed between the groups requiring PGE reinitiation (79.2% ± 4.7%) and those not needing reinitiation (89.0% ± 2.0%) (P < 0.001). The relative risk for the reinitiation group with BAS oxygen saturation levels ≤80% was 2.5 (95% confidence interval: 1.3-4.6). No disparity was observed in postoperative outcomes or PGE adverse effects such as fever, apnoea, bradycardia, and congestive heart failure requiring diuretic between the groups.

Conclusions

Given no significant differences in PGE adverse effects and a 2.5 times higher risk of reinitiation with post-BAS saturation below 80%, maintaining PGE until saturation reaches 80% for a few days before discontinuation may help reduce the risk of rebound hypoxaemia.

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球囊心房隔膜切除术后 d 型移位术前使用前列腺素 E1 的必要性

背景对于球囊心房隔成形术（BAS）后大动脉d型横位（dTGA）婴儿在动脉转换手术（ASO）前使用前列腺素E1（PGE）的必要性仍存在争议。分析的参数包括BAS后血氧饱和度、从BAS到PGE停用的时间、重新启用的必要性、PGE重新启用前的间隔时间以及PGE重新启用前的最低血氧饱和度。结果在35例接受ASO的dTGA病例中，31例（88%）需要进行BAS，23例（65%）需要输注PGE。在这 23 名婴儿中，14 名（60%）在停用 PGE 后需要重新使用。在需要重新启动 PGE 的组别（79.2% ± 4.7%）和不需要重新启动的组别（89.0% ± 2.0%）之间，观察到 BAS 后血氧饱和度存在明显差异（P < 0.001）。BAS 血氧饱和度≤80%的重启组相对风险为 2.5（95% 置信区间：1.3-4.6）。结论鉴于 PGE 不良反应无显著差异，且 BAS 后血氧饱和度低于 80% 时重新启动的风险高出 2.5 倍，因此在停用前几天维持 PGE 直到饱和度达到 80%，可能有助于降低反跳性低氧血症的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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CJC Pediatric and Congenital Heart Disease

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