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

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Surgical Interventions

Background:

• The necessity of prostaglandin E1 (PGE) infusion before arterial switch operation (ASO) in infants with d-transposition of the great arteries (dTGA) following balloon atrial septostomy (BAS) is not definitively established.
• Controversy exists regarding optimal PGE management strategies in dTGA patients post-BAS.

Purpose of the Study:

• To evaluate the necessity and impact of prostaglandin E1 (PGE) usage in infants with d-transposition of the great arteries (dTGA) undergoing arterial switch operation (ASO) after balloon atrial septostomy (BAS).
• To identify predictors for PGE reinitiation and assess its association with clinical outcomes.

Main Methods:

• A retrospective review of infants with dTGA who underwent ASO between January 2014 and December 2021 at a single center.
• Analysis of parameters including post-BAS oxygen saturation, timing of PGE discontinuation and reinitiation, and lowest saturation before reintroduction.

Main Results:

• Of 35 dTGA infants undergoing ASO, 31 (88%) had BAS, and 23 (65%) received PGE. Fourteen (60%) of those on PGE required reinitiation.
• Infants needing PGE reinitiation had significantly lower post-BAS oxygen saturation (79.2% ± 4.7%) compared to those who did not (89.0% ± 2.0%) (P < 0.001).
• A post-BAS saturation ≤80% increased the relative risk of PGE reinitiation by 2.5 times. No differences in postoperative outcomes or adverse PGE effects were noted.

Conclusions:

• Lower post-BAS oxygen saturation (<80%) is associated with a higher risk of prostaglandin E1 (PGE) reinitiation in dTGA infants undergoing ASO.
• Maintaining PGE infusion until oxygen saturation stabilizes above 80% for a few days post-BAS may reduce the risk of rebound hypoxemia.
• Current evidence suggests careful monitoring and tailored PGE management can optimize outcomes without increasing adverse effects.