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Feb 05, 2014

Time is of the Essence When Treating Babies with d-TGA

Study suggests that performing surgery on the third day of life is ideal for babies born with the rare birth defect.

Congenital heart defects are the most common type of birth defect in the United States, affecting nearly 1% of births each year. And according to a recent study, performing surgery in the first few days of life could be key to treating a rare birth defect, d-TGA (dextro-Transposition of the Great Arteries).

When a baby is born with d-TGA, the two main arteries carrying blood out of the heart are reversed. Typically, babies born with this condition undergo surgery, called an arterial switch operation, to restore normal blood flow through the heart. However, it’s unclear exactly when is the best time to perform this life-saving surgery. While the arterial switch operation is usually performed within the first month of life, little research has demonstrated ideal timing—until now.

A study published in the Journal of the American College of Cardiology identified 140 children with d-TGA admitted to the New York-Presbyterian/Morgan Stanley Children’s Hospital of Columbia University between 2003 and 2012. All children included in the study were admitted to the hospital at five days old or younger and underwent surgery to correct their heart defect during their hospital stay.

After analysis, researchers found that overall risk of death was 1.4%, while 20% of patients experienced significant complications following surgery. Most patients underwent surgery when they were five days old, but researchers found that waiting to perform surgery until children were three days old increased risk of negative outcomes. For every day that surgeons waited past three days old, risk of complications increased by nearly 50%. Further, costs increased by 8% with each day that passed after a patient was three days old.

Based on these findings, researchers conclude that performing surgery to correct d-TGA at three days old is the best possible time for operation. Although further research is needed to understand ideal timing for surgery, this study emphasizes the importance of planning ahead to treat babies born with this rare birth defect. These days, many women schedule their deliveries and authors suggest that they coordinate with surgeons’ schedules to minimize wait times. Similarly, infants born in hospitals that don’t perform corrective surgery should be transferred to a hospital that can perform the life-saving operation as quickly as possible after delivery. By reducing wait times for surgery, patients with d-TGA may have a greater chance of survival and lower risk of complications.
Read the full study in the Journal of the American College of Cardiology

Questions for You to Consider

  • What is d-TGA (dextro-Transposition of the Great Arteries)?
  • D-TGA is a rare heart defect that affects roughly 4,000 babies born in the United States each year. When a baby is born with d-TGA, the two main arteries that carry blood out of the heart are reversed. Most babies born with d-TGA require surgery soon after birth to fix the reversed arteries and restore normal blood flow to the rest of the body.
  • How common are heart defects?
  • Heart defects are the most common type of birth defect, affecting roughly 1% of all births in the United States each year.

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