Prenatal diagnosis, hospital characteristics, and mortality in transposition of the great arteries

Diego A. Lara, David E Fixler, Mary K. Ethen, Mark A. Canfield, Wendy N. Nembhard, Shaine A. Morris

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: The role of prenatal diagnosis in reducing neonatal mortality from transposition of the great arteries (TGA) is controversial. Factors affected by prenatal diagnosis such as proximity at birth to a cardiac surgical center (CSC) and CSC volume are associated with mortality in congenital heart disease. The purpose of the study was to determine the associations between prenatal diagnosis, distance from birthplace to a CSC, CSC TGA volume, and neonatal mortality in patients with TGA. Methods: The Texas Birth Defects Registry was queried for all live born infants with TGA from 1999 to 2007. Four hundred sixty-eight cases of TGA were included. Results: Forty-eight patients (10.3%) were prenatally diagnosed, and 20 patients died before age 28 days (4.3%). Neither prenatal diagnosis nor close proximity to a CSC at birth (p > 0.05) were associated with decreased mortality. Low CSC TGA volume was associated with increased mortality (p < 0.0002). Mortality at the CSCs with <5 patients per year was 9.6%; CSCs with 5 to 10 patients per year had 0% mortality, and those with >10 patients per year had 2.3% mortality. In multivariable logistic regression, only preterm birth (odds ratio, 7.05; 95% confidence interval, 4.13–12.05) and lower CSC volume (p < 0.001) were associated with neonatal mortality, although prenatal diagnosis attenuated the detrimental association of lower volume CSCs with higher mortality (p for interaction = 0.047). Conclusion: Lower CSC TGA patient volume was associated with higher neonatal mortality. Prenatal diagnosis may improve survival in lower volume CSCs. Birth Defects Research (Part A) 106:739–748, 2016.

Original languageEnglish (US)
Pages (from-to)739-748
Number of pages10
JournalBirth Defects Research Part A - Clinical and Molecular Teratology
Volume106
Issue number9
DOIs
StatePublished - Sep 1 2016

Fingerprint

Transposition of Great Vessels
Hospital Mortality
Prenatal Diagnosis
Infant Mortality
Mortality
Birthing Centers
Premature Birth
Registries
Heart Diseases
Logistic Models
Odds Ratio
Parturition
Confidence Intervals
Survival
Research

Keywords

  • arterial switch operation
  • congenital heart disease
  • hospital volume
  • mortality
  • prenatal diagnosis
  • surgical outcomes
  • transposition of the great arteries

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Embryology
  • Developmental Biology

Cite this

Prenatal diagnosis, hospital characteristics, and mortality in transposition of the great arteries. / Lara, Diego A.; Fixler, David E; Ethen, Mary K.; Canfield, Mark A.; Nembhard, Wendy N.; Morris, Shaine A.

In: Birth Defects Research Part A - Clinical and Molecular Teratology, Vol. 106, No. 9, 01.09.2016, p. 739-748.

Research output: Contribution to journalArticle

Lara, Diego A. ; Fixler, David E ; Ethen, Mary K. ; Canfield, Mark A. ; Nembhard, Wendy N. ; Morris, Shaine A. / Prenatal diagnosis, hospital characteristics, and mortality in transposition of the great arteries. In: Birth Defects Research Part A - Clinical and Molecular Teratology. 2016 ; Vol. 106, No. 9. pp. 739-748.
@article{3a2d3a7b19fc4fecba0eeeeedddfaa06,
title = "Prenatal diagnosis, hospital characteristics, and mortality in transposition of the great arteries",
abstract = "Background: The role of prenatal diagnosis in reducing neonatal mortality from transposition of the great arteries (TGA) is controversial. Factors affected by prenatal diagnosis such as proximity at birth to a cardiac surgical center (CSC) and CSC volume are associated with mortality in congenital heart disease. The purpose of the study was to determine the associations between prenatal diagnosis, distance from birthplace to a CSC, CSC TGA volume, and neonatal mortality in patients with TGA. Methods: The Texas Birth Defects Registry was queried for all live born infants with TGA from 1999 to 2007. Four hundred sixty-eight cases of TGA were included. Results: Forty-eight patients (10.3{\%}) were prenatally diagnosed, and 20 patients died before age 28 days (4.3{\%}). Neither prenatal diagnosis nor close proximity to a CSC at birth (p > 0.05) were associated with decreased mortality. Low CSC TGA volume was associated with increased mortality (p < 0.0002). Mortality at the CSCs with <5 patients per year was 9.6{\%}; CSCs with 5 to 10 patients per year had 0{\%} mortality, and those with >10 patients per year had 2.3{\%} mortality. In multivariable logistic regression, only preterm birth (odds ratio, 7.05; 95{\%} confidence interval, 4.13–12.05) and lower CSC volume (p < 0.001) were associated with neonatal mortality, although prenatal diagnosis attenuated the detrimental association of lower volume CSCs with higher mortality (p for interaction = 0.047). Conclusion: Lower CSC TGA patient volume was associated with higher neonatal mortality. Prenatal diagnosis may improve survival in lower volume CSCs. Birth Defects Research (Part A) 106:739–748, 2016.",
keywords = "arterial switch operation, congenital heart disease, hospital volume, mortality, prenatal diagnosis, surgical outcomes, transposition of the great arteries",
author = "Lara, {Diego A.} and Fixler, {David E} and Ethen, {Mary K.} and Canfield, {Mark A.} and Nembhard, {Wendy N.} and Morris, {Shaine A.}",
year = "2016",
month = "9",
day = "1",
doi = "10.1002/bdra.23525",
language = "English (US)",
volume = "106",
pages = "739--748",
journal = "Teratology",
issn = "1542-0752",
publisher = "Wiley-Liss Inc.",
number = "9",

}

TY - JOUR

T1 - Prenatal diagnosis, hospital characteristics, and mortality in transposition of the great arteries

AU - Lara, Diego A.

AU - Fixler, David E

AU - Ethen, Mary K.

AU - Canfield, Mark A.

AU - Nembhard, Wendy N.

AU - Morris, Shaine A.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background: The role of prenatal diagnosis in reducing neonatal mortality from transposition of the great arteries (TGA) is controversial. Factors affected by prenatal diagnosis such as proximity at birth to a cardiac surgical center (CSC) and CSC volume are associated with mortality in congenital heart disease. The purpose of the study was to determine the associations between prenatal diagnosis, distance from birthplace to a CSC, CSC TGA volume, and neonatal mortality in patients with TGA. Methods: The Texas Birth Defects Registry was queried for all live born infants with TGA from 1999 to 2007. Four hundred sixty-eight cases of TGA were included. Results: Forty-eight patients (10.3%) were prenatally diagnosed, and 20 patients died before age 28 days (4.3%). Neither prenatal diagnosis nor close proximity to a CSC at birth (p > 0.05) were associated with decreased mortality. Low CSC TGA volume was associated with increased mortality (p < 0.0002). Mortality at the CSCs with <5 patients per year was 9.6%; CSCs with 5 to 10 patients per year had 0% mortality, and those with >10 patients per year had 2.3% mortality. In multivariable logistic regression, only preterm birth (odds ratio, 7.05; 95% confidence interval, 4.13–12.05) and lower CSC volume (p < 0.001) were associated with neonatal mortality, although prenatal diagnosis attenuated the detrimental association of lower volume CSCs with higher mortality (p for interaction = 0.047). Conclusion: Lower CSC TGA patient volume was associated with higher neonatal mortality. Prenatal diagnosis may improve survival in lower volume CSCs. Birth Defects Research (Part A) 106:739–748, 2016.

AB - Background: The role of prenatal diagnosis in reducing neonatal mortality from transposition of the great arteries (TGA) is controversial. Factors affected by prenatal diagnosis such as proximity at birth to a cardiac surgical center (CSC) and CSC volume are associated with mortality in congenital heart disease. The purpose of the study was to determine the associations between prenatal diagnosis, distance from birthplace to a CSC, CSC TGA volume, and neonatal mortality in patients with TGA. Methods: The Texas Birth Defects Registry was queried for all live born infants with TGA from 1999 to 2007. Four hundred sixty-eight cases of TGA were included. Results: Forty-eight patients (10.3%) were prenatally diagnosed, and 20 patients died before age 28 days (4.3%). Neither prenatal diagnosis nor close proximity to a CSC at birth (p > 0.05) were associated with decreased mortality. Low CSC TGA volume was associated with increased mortality (p < 0.0002). Mortality at the CSCs with <5 patients per year was 9.6%; CSCs with 5 to 10 patients per year had 0% mortality, and those with >10 patients per year had 2.3% mortality. In multivariable logistic regression, only preterm birth (odds ratio, 7.05; 95% confidence interval, 4.13–12.05) and lower CSC volume (p < 0.001) were associated with neonatal mortality, although prenatal diagnosis attenuated the detrimental association of lower volume CSCs with higher mortality (p for interaction = 0.047). Conclusion: Lower CSC TGA patient volume was associated with higher neonatal mortality. Prenatal diagnosis may improve survival in lower volume CSCs. Birth Defects Research (Part A) 106:739–748, 2016.

KW - arterial switch operation

KW - congenital heart disease

KW - hospital volume

KW - mortality

KW - prenatal diagnosis

KW - surgical outcomes

KW - transposition of the great arteries

UR - http://www.scopus.com/inward/record.url?scp=84978435528&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84978435528&partnerID=8YFLogxK

U2 - 10.1002/bdra.23525

DO - 10.1002/bdra.23525

M3 - Article

C2 - 27296724

AN - SCOPUS:84978435528

VL - 106

SP - 739

EP - 748

JO - Teratology

JF - Teratology

SN - 1542-0752

IS - 9

ER -