The Need for Preoperative Prostaglandin E1 for d-Transposition After Balloon Atrial Septostomy

Background: The necessity of prostaglandin E1 (PGE) usage before arterial switch operation (ASO) in infants with d-transposition of the great arteries (dTGA) after balloon atrial septostomy (BAS) remains controversial. Methods: This study is a single-centre, retrospective review of infants with dTGA who underwent ASO from January 2014 to December 2021. Parameters analysed included post-BAS oxygen saturation, time from BAS to PGE discontinuation, necessity of reinitiation, interval before PGE restart, and lowest saturation before PGE reintroduction. Results: Among the 35 cases of dTGA who underwent ASO, 31 (88%) required BAS, with 23 (65%) requiring PGE infusion. Of those 23 infants, 14 (60%) necessitated PGE reinitiation after discontinuation. A significant difference in post-BAS oxygen saturation was observed between the groups requiring PGE reinitiation (79.2% ± 4.7%) and those not needing reinitiation (89.0% ± 2.0%) (P < 0.001). The relative risk for the reinitiation group with BAS oxygen saturation levels ≤80% was 2.5 (95% confidence interval: 1.3-4.6). No disparity was observed in postoperative outcomes or PGE adverse effects such as fever, apnoea, bradycardia, and congestive heart failure requiring diuretic between the groups. Conclusions: Given no significant differences in PGE adverse effects and a 2.5 times higher risk of reinitiation with post-BAS saturation below 80%, maintaining PGE until saturation reaches 80% for a few days before discontinuation may help reduce the risk of rebound hypoxaemia.