When to do the Arterial Switch Operation to Optimize Outcomes and Resource Utilization: A National Database Analysis
Presented During:
Sunday, April 28, 2024: 9:51AM - 9:58AM
Metro Toronto Convention Center
Posted Room Name:
Room 716
Abstract No:
133
Submission Type:
Abstract Submission
Authors:
Muhammad Faateh (1), Hosam Ahmed (1), Muhammad Aanish Raees (1), David Lehenbauer (1), James F. Cnota (1), David Morales, Sr. (1), Awais Ashfaq (1)
Institutions:
(1) The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Submitting Author:
Muhammad Faateh
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The Heart Institute, Cincinnati Children's Hospital Medical Center
The Heart Institute, Cincinnati Children's Hospital Medical Center
Co-Author(s):
Hosam Ahmed
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The Heart Institute, Cincinnati Children's Hospital Medical Center
The Heart Institute, Cincinnati Children's Hospital Medical Center
Muhammad Aanish Raees
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The Heart Institute, Cincinnati Children's Hospital Medical Center
The Heart Institute, Cincinnati Children's Hospital Medical Center
David Lehenbauer
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The Heart Institute, Cincinnati Children's Hospital Medical Center
The Heart Institute, Cincinnati Children's Hospital Medical Center
James F. Cnota
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The Heart Institute, Cincinnati Children's Hospital Medical Center
The Heart Institute, Cincinnati Children's Hospital Medical Center
*David Morales, Sr.
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The Heart Institute, Cincinnati Children's Hospital Medical Center
The Heart Institute, Cincinnati Children's Hospital Medical Center
Awais Ashfaq
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The Heart Institute, Cincinnati Children's Hospital Medical Center
The Heart Institute, Cincinnati Children's Hospital Medical Center
Presenting Author:
Muhammad Faateh
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Abstract:
Objective:The optimal timing of Arterial Switch Operation(ASO) has been a matter of debate in patients with d-TGA(d-Transposition of Great Arteries). We sought to examine characteristics, outcomes, & costs of early versus late ASO for d-TGA + IVS(Intact Ventricular Septum) from a large national database.
Methods:The Pediatric Health Informational System was queried from 2004-2022 to identify patients with d-TGA undergoing ASO. Patients were excluded if they had a VSD, arch reconstruction, concomitant defects or if ASO was performed >30 day of life. Patients were divided according to age at ASO:very early(0-3 d), early(4-7 d), late(8-14 d) & very late(15-30 d) groups. Baseline characteristics, demographics, use of balloon atrial septostomy(BAS), prostaglandin(PGE) & Nitric oxide(iNO) were analyzed. In-hospital outcomes including post-op mortality, need for ECMO, dialysis, delayed sternum closure, ICU length of stay, total costs of hospitalization were compared.
Results:A total of 3,556 patients/ASO cases were identified of which 21.7%(n=773) were very early, 51.0%(n=1,815) early, 21.1%(n=752) late & 6.1%(n=216) were very late. The median age at ASO was 6 days(IQR 4-8). Patients were similar in gender & race/ethnicity & presence of ASD. Patients in the late & very late groups were more likely to be preterm, have lower birthweight & have government insurance vs very early & early ASO groups. They were also more likely to have pre-op stroke, iNO use, BAS, & pre-op ECMO use(all P<0.05). Overall, in-hospital mortality was 1.4% & was similar between groups (p=0.15). Late & very late groups had higher rates of non-home discharge, post-op ECMO use, delayed sternum closure & longer ICU LOS. There was an incremental increase in the composite outcome of in-hospital death/non-home discharge/post-op ECMO/delayed sternum closure by timing of ASO( in order, v early to v late,): 8% vs 9.6% vs 16.2% vs 25.0%. On multivariate analysis, patients in [late & v late groups] vs [v early & early groups] had almost double the odds of developing composite outcome(aOR 1.97, 95%CI: 1.57-2.43, p<0.001).Median total adjusted costs of hospitalization were significantly higher in late & very late ASO groups (Very Early: $115,060; Early: $129,297; Late: $162,746; Very Late: $213,707)(Table)
Conclusions:This is the largest study examining timing of ASO in a cohort exclusively of d-TGA + IVS. ASO performed late (>7 days) resulted in worse outcomes & higher healthcare resource utilization.
Methods:The Pediatric Health Informational System was queried from 2004-2022 to identify patients with d-TGA undergoing ASO. Patients were excluded if they had a VSD, arch reconstruction, concomitant defects or if ASO was performed >30 day of life. Patients were divided according to age at ASO:very early(0-3 d), early(4-7 d), late(8-14 d) & very late(15-30 d) groups. Baseline characteristics, demographics, use of balloon atrial septostomy(BAS), prostaglandin(PGE) & Nitric oxide(iNO) were analyzed. In-hospital outcomes including post-op mortality, need for ECMO, dialysis, delayed sternum closure, ICU length of stay, total costs of hospitalization were compared.
Results:A total of 3,556 patients/ASO cases were identified of which 21.7%(n=773) were very early, 51.0%(n=1,815) early, 21.1%(n=752) late & 6.1%(n=216) were very late. The median age at ASO was 6 days(IQR 4-8). Patients were similar in gender & race/ethnicity & presence of ASD. Patients in the late & very late groups were more likely to be preterm, have lower birthweight & have government insurance vs very early & early ASO groups. They were also more likely to have pre-op stroke, iNO use, BAS, & pre-op ECMO use(all P<0.05). Overall, in-hospital mortality was 1.4% & was similar between groups (p=0.15). Late & very late groups had higher rates of non-home discharge, post-op ECMO use, delayed sternum closure & longer ICU LOS. There was an incremental increase in the composite outcome of in-hospital death/non-home discharge/post-op ECMO/delayed sternum closure by timing of ASO( in order, v early to v late,): 8% vs 9.6% vs 16.2% vs 25.0%. On multivariate analysis, patients in [late & v late groups] vs [v early & early groups] had almost double the odds of developing composite outcome(aOR 1.97, 95%CI: 1.57-2.43, p<0.001).Median total adjusted costs of hospitalization were significantly higher in late & very late ASO groups (Very Early: $115,060; Early: $129,297; Late: $162,746; Very Late: $213,707)(Table)
Conclusions:This is the largest study examining timing of ASO in a cohort exclusively of d-TGA + IVS. ASO performed late (>7 days) resulted in worse outcomes & higher healthcare resource utilization.
CONGENTIAL:
Neonatal and Pediatric Cardiac Surgery
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