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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: thomas.krasemann@gstt.nhs.uk
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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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