Should we standardise the pre-operative management of babies with complete transposition?

Complete transposition is the most common form of neonatal cyanotic heart disease. The management of this condition has changed markedly in the last decade and there appears to be a significant variation between centres in terms of pre-operative management.

We surveyed all paediatric cardiac surgical centres in the United Kingdom regarding pre-operative management, particularly performance and timing of balloon atrial septostomy and aortogram, imaging techniques used and discharge prior to surgery.

There is significant variation in pre-operative management: 10 centres now perform septostomy outside the catheter lab and 11 without general anaesthesia. Eight centres use echo control only and only 3 perform routine aortograms. Three centres do not perform routine septostomy. The most common age for arterial switch was at 1-2 weeks, but some routinely performed this procedure up to 1 month of age and others aim for arterial switch before one week of age. Only 3 centres routinely discharge patients between septostomy and switch.

Despite a trend towards echo guided septostomy and earlier arterial switch there is still considerable variation in early management of patients with transposition of the great arteries. Debate within the profession leading to a more standardised pre-operative management strategy would protect both the patient and the doctor involved in the care of children with complete transposition.