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

Abstract

Objective A recent STS database study showed that low weight (<2.5 kg) at surgery was associated with a high operative mortality (16%). We thought to assess outcomes after cardiac repair in patients <2.5 kg as compared to 2.5-4.5kg in an institution with a dedicated neonatal cardiac program; and to determine the potential role played by prematurity, STAT risk categories, uni/biventricular pathway, and timing of surgery. Methods We analyzed outcomes (hospital mortality, early reintervention, postoperative length of stay (postopLOS), mortality (at last follow-up) in patients <2.5kg at time of surgery (n=146; group1) and 2.5-4.5kg (n=622; group2), who underwent open or closed cardiac repairs from January 2006 to December 2012 at our institution. The statistical analysis was stratified by prematurity, STAT risk categories, uni/biventricular pathway and “usual”/“delayed” timing of surgery. A uni/multivariate risk analysis was performed. Mean follow-up was 21.6±25.6 months. Results Hospital mortality in group 1 was 10.9% (n=16) vs. 4.8% (n=30) in group 2 (p=0.007). PostopLOS and early un-planned reintervention rates were similar between the two groups. Late mortality in group 1 was 0.7% (n=1). In Group 1, early outcomes were independent of STAT risk categories, uni/biventricular pathway or timing of surgery, as opposed to group 2. Lower gestational age at birth was an independent risk factor for early mortality in group 1. Conclusions A dedicated multidisciplinary neonatal cardiac program yields good outcomes for neonates and infants <2.5kg independently of STAT risk categories and uni/biventricular pathway. Lower gestational age at birth was an independent risk factor for hospital mortality.

The Impact of Dominant Ventricle Morphology on Palliation Outcomes of Single Ventricle Anomalies

“…Moreover, other patient characteristics have been shown to be associated with poor single ventricle palliation outcomes, such as prematurity, low weight, and genetic syndromes and extracardiac anomalies [11,[13][14][15][16][17][18][19][23][24][25][26]. The distribution of the associated risk factors such as genetic syndromes and extracardiac anomalies among patients with a single ventricle is not uniform, with high association of those lesions with certain single ventricle anomalies (for example, present in 100% of heterotaxy patients by definition) and low association with other single ventricle anomalies (for example, very few patients with double inlet left ventricle have other lesions).…”

Mandibular Distraction Osteogenesis in Low-Weight Neonates with Robin Sequence

“…We chose <4 kg as our study population as surgical risk and complexity in other pediatric surgery specialties is associated with children who are low weight at the time of surgery, and the CPT code modifier uses the weight limit of 4 kg. [30][31][32] One of the earliest reports by Denny on the use of MDO for the treatment of RS described 5 successfully treated patients who were under 4 kg at the time of surgery. 5 There are several other reports on MDO for the treatment of RS, however these reports either describe a large patient population 2 or make no specific mention of weight at the time of surgery.…”

Two‐stage approach for surgical treatment of tetralogy of Fallot in underweight children: Clinical and morphological outcomes

“…Current improvements in cardiac surgery and anesthesiology reduced the case fatality rate to 0.5‐2.5%; however, surgical reconstruction of certain ToF types is challenging. Low body weight, intrauterine growth retardation, preterm birth, and concomitant malformations all are among the risk factors for an adverse outcome, hence being relative or absolute contraindications for utilizing a standard one‐stage surgical approach for ToF management . For such patients, two‐stage surgical treatment with the physiological remodeling of both left ventricle and pulmonary artery was suggested as an appropriate option .…”

“…Low body weight, intrauterine growth retardation, preterm birth, and concomitant malformations all are among the risk factors for an adverse outcome, hence being relative or absolute contraindications for utilizing a standard one-stage surgical approach for ToF management. [3][4][5][6] For such patients, two-stage surgical treatment with the physiological remodeling of both left ventricle and pulmonary artery was suggested as an appropriate option. 7,8 This strategy enables to achieve an adequate pulmonary perfusion employing aortopulmonary shunt followed by total surgical repair (TSG) after an increase in body weight and heart size.…”