review · Pediatric Cardiology
Neonates born with a congenital heart condition known as dextro-transposition of the great arteries often require corrective arterial switch surgery. To stabilise infants before surgery, clinicians sometimes perform balloon atrial septostomy, an invasive catheter procedure intended to improve blood mixing. A systematic review and meta-analysis evaluating twenty-eight studies investigated the association between this preliminary procedure and perioperative outcomes. The pooled data demonstrated that prior balloon atrial septostomy was not associated with a significant reduction in overall mortality. Patients who underwent the procedure had substantially higher rates of pre-operative intubation, which probably reflects greater illness severity rather than procedural harm. Overall hospital length of stay did not differ significantly between groups, and prospective imaging showed no clear link to pre-operative brain injury. Current evidence remains insufficient to confirm clear survival benefits.
Treating newborns with complex congenital heart defects requires difficult decisions regarding when to intervene before major surgery. Because hospitals currently show marked variation in performing preliminary septostomy procedures, these findings help clinicians and healthcare managers critically evaluate whether routine catheterisation offers tangible survival benefits or simply adds procedural complexity to neonatal care.
The abstract does not indicate an application pathway, as it provides a systematic evaluation of existing clinical procedures rather than a commercial product or new technology.
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The role of balloon atrial septostomy (BAS) in the contemporary management of neonates with dextra-transposition of the great arteries (d-TGA) undergoing arterial switch operation (ASO) remains controversial, with marked inter-institutional practice variation and conflicting outcome data. We evaluated the association between prior BAS and mortality, length of stay, pre-operative intubation rate, and neurological outcomes in neonates with d-TGA undergoing ASO, with pre-specified subgroup analyses stratified by TGA anatomical subtype. We conducted a systematic review and meta-analysis of studies reporting outcomes in neonates with d-TGA undergoing ASO with and without prior BAS. Databases were searched from inception to 2024. Risk of bias was assessed using ROBIN-I. Random-effects meta-analyses were performed for mortality, length of stay, and pre-operative intubation rate. Studies reporting only adjusted effect estimates without counts data were described narratively. The protocol was registered in PROSPERO (CRD420251041501). Twenty-eight studies (1983-2024) were included. Six contributed to mortality analysis (n=1151; 43 deaths). The pooled odds ratio (OR) for mortality was 0.73 (95% CI 0.40-1.34, I2 = 0%). In TGA-IVS (4 studies, n = 443), OR was 0.89 (95% CI 0.30-2.65; I2 = 0%). in mixed TGA (2 studies, n=708), OR was 0.66 (95% CI 0.27-1.62, I2 = 34%), with no significant subgroup difference. Sensitivity analysis showed similar results. Overall length of stay did not differ significantly, though TGA-IVS neonates showed moderately longer pre-operative stay. Pre-operative intubation was more frequent with BAS (OR 8.96, 95% CI 3.69-21.71). Prospective MRI studies showed no clear association with pre-operative brain injury. Prior BAS was not associated with reduced mortality in neonates with d-TGA undergoing ASO. Higher intubation rates likely reflect illness severity rather than harm. This evidence does not exclude benefit in selected high-risk neonates but remains insufficient to confirm it.
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DOI: 10.1007/s00246-026-04446-2
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