Critical Congenital Heart Diseases in Preterm Neonates: Is Early Cardiac Surgery Quite Reasonable?

Abstract

Prematurity is a recognized risk factor for morbidity and mortality following cardiac surgery. Postoperative and long-term outcomes after cardiac surgery performed in the preterm period are poorly described. The aim of this study was to analyze a population of preterm neonates operated on for critical congenital heart disease (CHD) before 37 weeks of gestational age (wGA) with special attention given to early and late mortality and morbidity. Between 2000 and 2013, 28 preterm neonates (median gestational age (GA) 34.3 weeks) underwent cardiopulmonary bypass (CPB) surgery for critical CHD before 37 wGA; records were retrospectively reviewed. All patients except three with single ventricle physiology had a single-stage anatomic repair. Overall mortality was 43 % (95 % CI 25-62). Risk factors for death were birth weight (p = 0.032) and weight at surgery (p = 0.037), independently of GA, preoperative status, CPB and aortic clamp time. Seven patients, including those with univentricular hearts, died during the postoperative period, and five in the first year after surgery. Median follow-up was 5.9 years (range 1 month-12.8 years). Kaplan-Meier survival rate was 75 % (95 % CI 59-91) at 1 month, and 57 % (95 % CI 39-75) at 1 and 5 years. Eight patients required reoperations after a delay of 2.8 ± 1.3 months; eight had bronchopulmonary dysplasia. At the end of follow-up, nine patients were asymptomatic. One-stage biventricular repair for critical CHD on preterm neonates was feasible. Mortality remained high but acceptable, mainly confined to the first postoperative year and related to small weight. Despite reoperations, long-term clinical status was good in most survivors. Further long-term prospective investigations are necessary to evaluate neurodevelopmental outcomes.

Impact of Gestational Age on Surgical Outcomes in Patients With Functionally Single Ventricle

“…Prematurity also manifests as multiple extracardiac detriments, including difficulties in postoperative management associated with low body weight (at birth or at initial palliation), respiratory distress syndrome, bronchopulmonary dysplasia, pulmonary hypertension, genetic abnormality, and hepatorenal dysfunction. [1][2][3][4] These issues may persist even long after the initial palliation and may lead to attrition from the Fontan track. [5][6][7] Research has demonstrated that the deleterious effect of younger GA applies not only to premature infants but also to the neonates born at early term.…”

“…However premature and early-term birth (ie, gestational age [GA] between 37 þ0 and 38 þ6 weeks) are still significant risk factors for increased morbidity and mortality after single-ventricle palliation (SVP). [1][2][3][4][5][6][7][8] Deleterious effect of younger GA may be alleviated by delaying the initial palliation, but the benefits from deferral of initial surgical palliation in terms of higher survival and lower attrition from the Fontan track are still controversial. 3,9 In this study we sought to determine the impact of GA and postmenstrual age (PMA; GA plus postnatal age) at initial palliation on surgical outcomes of SVP, focusing on the risk of interstage mortality (ISM) from each stage of the Fontan track.…”

Cardiopulmonary bypass reduces myocardial oxidative stress, inflammation and increases c-kit+CD45− cell population in newborns

“…Nevertheless, considerable mortality rate in neonates rather than older children in association with corrective cardiac surgery are still challenging. Neonates needing surgical intervention early in life still have significantly higher mortality rates than infants and older children beyond the neonatal period [ 9 , 10 ]. Corrective cardiac surgery is the most responsible cause for mortality in neonates and infants [ 11 ].…”

Differential expression of microRNAs following cardiopulmonary bypass in children with congenital heart diseases

“…However, considerable mortality rates in neonates rather than older children in association with corrective cardiac surgery remain challenging [1–5]. Neonates needing surgical intervention in early life still have significantly higher mortality than infants and older children [6, 7]. Corrective cardiac surgery is one of the most major cause of mortality in neonates and infants [8].…”