Cardiac surgery in low birth weight infants: current outcomes☆

Abstract

Low birth weight (LBW) is a risk factor for mortality in neonatal and infant heart surgery. The purpose of this study was to determine the contemporary outcomes and risk factors of cardiac surgery in low weight babies. The records of 75 consecutive infants weighing <2.5 kg having heart surgery were reviewed. The median weight was 2100 g (range 800-2500 g) and median age was 11 days (range 2-86 days). Half (n=38) of the infants were premature. Diagnoses included: arch obstruction (n=14), hypoplastic left heart syndrome (HLHS) (n=12), tetralogy of Fallot (ToF) or pulmonary atresia (PA)/ventricular septal defect (VSD) (n=11), transposition of the great arteries (TGA) (n=7), total anomalous pulmonary venous return (TAPVR) (n=5), and other (n=20). There were two early deaths. Follow-up was available on all infants with a median duration of 1320 days (range 6-3055 days). Cumulative Kaplan-Meier survival at one year was 90% [95% confidence interval (CI), 80-95%] and at five years was 88% (95% CI, 77-94%). Overall mortality amongst patients with genetic/chromosomal abnormalities was higher, 28% vs. 5.4% amongst patients without such abnormalities (P=0.008). Age, prematurity, preoperative mechanical ventilation, prostaglandins, non-cardiac organ dysfunction, extra-cardiac malformations, perioperative extracorporeal membrane oxygenation (ECMO), and type of procedure were not associated with significant differences in mortality. Cardiac surgery in LBW infants can be performed with low early and mid-term mortality. LBW infants with chromosomal/genetic anomalies have a higher risk.

Outcomes of cardiac surgery in patients weighing <2.5 kg: Affect of patient-dependent and -independent variables

“…Moreover, overall outcomes other than hospital mortality, such as postoperative length of stay, early unplanned reintervention rate and mid-term mortality rate in patients <2.5kg were not higher than those of patients>2.5kg. Such excellent early and mid-term outcomes reported in our series and others 4, 20 may rely on the expertise acquired by a multidisciplinary team dedicated to neonatal cardiac care in the setting of a high-volume program.…”

“…Curzon et al 2 demonstrated in the STS database series that lower weight consistently increased risk of mortality after risk stratification. Palliation for a univentricular heart, diagnosis of HLHS and performance of a Norwood procedure have been reported as a risk factor for adverse outcome following cardiac surgery in low-weight infants 1-4, 8, 19, 21 . The reason for neutralization of risk categories and univentricular palliation as a risk factor in our series does not seem to be explained by a lack of statistical power since the STAT 5 category group and univentricular pathway group are one the most important groups in our series.…”

Risk factors of sepsis after open congenital cardiac surgery in infants: a pilot study

“…43 In our observation, 85.7% of the subjects who suffered from sepsis had a poor nutritional status; this finding, however, showed no significant finding on bivariate analyses (RR=1.059, p=1.000). Our finding is supported by previous study by Azakie et al 44 in which they concluded that low birth weight or prematurity was related with a poor outcome in children who underwent open cardiac surgery; yet, the finding was not statistically significant. 44 These data might imply a better development of open cardiac surgical approach in premature or low and very low birth weight baby; hence, the previously significantly related risk factors were no longer found to be essential today.…”

Clinical outcomes in very low birth weight infants with major congenital heart defects

“…Mortality in all infants born before 28 weeks GA is high, and prior studies have found that, in infants with or without congenital heart defects, a 1–2-week increase in GA increases an infant’s odds of survival [5,14]. This is likely due to increased organ system maturation, particularly pulmonary maturation, and increased likelihood of a successful surgery to correct the heart defect [15,16]. …”