Savorgnan Fabio, Zaban Nicholas B, Elhoff Justin J, Ross Michael M, Breinholt John P
1Department of Pediatrics,Baylor College of Medicine,Houston,TX,USA.
2Department of Pediatrics,Indiana University School of Medicine,Indianapolis,IN,USA.
Cardiol Young. 2018 Dec;28(12):1421-1425. doi: 10.1017/S1047951118001439. Epub 2018 Aug 28.
Balloon atrial septostomy is performed in infants with dextro-transposition of the great arteries to improve oxygenation before surgery. It is performed in the catheterisation laboratory with fluoroscopy or at the bedside using echocardiography. It is unclear whether procedural safety and efficacy is superior in one location versus the other, although the bedside procedure may improve resource utilisation and present an opportunity for reducing cost. This study compares safety and efficacy of atrial septostomy performed at the patient's bedside versus the catheterisation laboratory.
Neonates with dextro-transposition of the great arteries who underwent balloon atrial septostomy from October, 2000 to January, 2014 were included. Medical and procedural records, echocardiograms, and catheterisation data were reviewed. Comparisons between the two procedural locations included patient demographics, pre- and post-procedure oxygen saturations, and outcomes. Complications reviewed included bleeding, arrhythmia, cardiac trauma, stroke, and death. Coronary artery evaluations were recorded. T-tests were used for continuous variables, and Fisher's exact tests were used for all categorical variables. Wilcoxon rank sum and analysis of covariance modelling were used for time variables and oxygen saturation, respectively.
A total of 88 infants met the inclusion criteria. Among them, 53 underwent septostomy at the bedside and 35 underwent septostomy in the catheterisation laboratory. No safety or outcome benefit was identified between the two procedural locations.
Septostomy performed at the bedside and in the catheterisation laboratory had similar outcomes and efficacy. Further, bedside septostomy has the advantage of no radiation exposure, and obviating risks with patient transfer from the ICU to the catheterisation laboratory.
大动脉右位转位的婴儿在手术前需进行球囊房间隔造口术以改善氧合。该手术可在导管室通过荧光透视进行，或在床边使用超声心动图进行。目前尚不清楚在一个地点进行手术与在另一个地点进行手术相比，其操作安全性和有效性是否更优，尽管床边手术可能会提高资源利用率并提供降低成本的机会。本研究比较了在患者床边与导管室进行房间隔造口术的安全性和有效性。
纳入2000年10月至2014年1月期间接受球囊房间隔造口术的大动脉右位转位新生儿。回顾医疗和手术记录、超声心动图及导管检查数据。两个手术地点之间的比较包括患者人口统计学特征、术前和术后氧饱和度以及手术结果。审查的并发症包括出血、心律失常、心脏创伤、中风和死亡。记录冠状动脉评估情况。连续变量采用t检验，所有分类变量采用Fisher精确检验。时间变量和氧饱和度分别采用Wilcoxon秩和检验和协方差分析模型。
共有88例婴儿符合纳入标准。其中，53例在床边进行了造口术，35例在导管室进行了造口术。在两个手术地点之间未发现安全性或手术结果方面的差异。
在床边和导管室进行的房间隔造口术具有相似的结果和疗效。此外，床边造口术的优点是无辐射暴露，且避免了患者从重症监护病房转移至导管室的风险。
