Pericardial Effusions After The Arterial Switch Operation: A Review Of The Pediatric Health Information System Database
Matthew F. Mikulski, MD, Andrew Well, MD MPH MSHCT, Sujata Subramanian, MD, Charles D. Fraser, Jr, MD, Carlos M. Mery, MD MPH, Richard P. Lion, DO MPH.
Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
Objective:
To analyze the short-term and longitudinal impact of post-operative pericardial effusions (PCE) after the arterial switch operation (ASO).Methods:
This is a review of the Pediatric Health Information System database from 01/01/2004 to 03/31/2022. All patients with dextro-Transposition of the Great Arteries who underwent ASO by ICD9/10 were identified. Demographics, outcomes, and hospital encounters were analyzed using descriptive, univariate, and multivariable logistic regression statistics.Results:
ASO occurred in 4896 patients. Of these, 1541(31.5%) were female, 3107(63.5%) White, 863(17.6%) Hispanic, with median gestational age of 39[IQR:38-39] weeks. Balloon atrial septostomy (BAS) occurred in 2287(46.7%) and 1281(26.2%) underwent ventricular septal defect (VSD) repair. PCE occurred in 207(4.2%) patients, with 27(13%) undergoing pericardiocentesis. Compared to those without PCE, PCE occurred less frequently in females (50(24.2%) vs 1491(31.8%), p=0.020), had higher rates of acute renal failure (ARF) (40(19.3%) vs 618(13.2%), p=0.011), and had longer post-operative length of stay (LOS) (15[IQR:10.5-22.5] vs 13[IQR:9-20] days, p=0.011). BAS and VSD repair were not associated with PCE. After adjustment (Table), females had lower odds of PCE and pleural effusions conferred higher odds. PCE had no impact on subsequent hospital encounters (1[0-2] vs 1[0-2], p=0.873) compared to no PCE.Conclusions:
PCE is an uncommon complication of ASO (4.2%), occurring less frequently in females. PCE was associated with pleural effusions and longer LOS, but had no impact on longitudinal hospital encounters.
| Factor | Odds Ratio of Pericardial Effusion | 95% CI | P value |
| Female | 0.66 | (0.48 - 0.92) | 0.014 |
| White | 1.12 | (0.79 - 1.57) | 0.529 |
| Gestational age (per week increase) | 0.99 | (0.98 - 1.01) | 0.301 |
| Low birth weight | 0.99 | (0.52 - 1.86) | 0.969 |
| Balloon atrial septostomy | 0.98 | (0.73 - 1.32) | 0.891 |
| Ventricular septal defect repair | 1.14 | (0.83 - 1.58) | 0.419 |
| Acute renal failure | 1.39 | (0.93 - 2.08) | 0.111 |
| Blood transfusion | 0.91 | (0.65 - 1.28) | 0.605 |
| Pleural effusion | 1.55 | (1.00 - 2.38) | 0.049 |
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