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Henmi S, Venna A, Haverty MC, Mehta R, Desai M, Tongut A, Yerebakan C, Donofrio MT, Munoz RA, d’Udekem Y. Survival benefits of the wait-and-grow approach in small babies (≤2000 g) requiring heart surgery. JTCVS OPEN 2024; 18:156-166. [PMID: 38690430 PMCID: PMC11056471 DOI: 10.1016/j.xjon.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/08/2023] [Accepted: 01/03/2024] [Indexed: 05/02/2024]
Abstract
Objective The best approach to minimize the observed higher mortality of newborn infants with low birth weight who require congenital heart surgery is unclear. This retrospective study was designed to review outcomes of newborn infants weighing <2000 g who have undergone cardiovascular surgery to identify patient parameters and clinical strategies for care associated with higher survival. Methods A retrospective chart review of 103 patients who underwent cardiovascular surgery from 2010 to 2021 who were identified as having low birth weight (≤2000 g). Patients who underwent only patent ductus arteriosus ligation or weighing >3500 g at surgery were excluded. Results Median age was 24 days and weight at the time of surgery was 1920 g. Twenty-six (25%) operative mortalities were recorded. Median follow-up period was 2.7 years. The 1- and 3-year overall Kaplan-Meier survival estimate was 72.4% ± 4.5% and 69.1% ± 4.6%. The 1-year survival of patients who had a weight increase >300 g from birth to surgery was far superior to the survival of those who did not achieve such a weight gain (81.4% ± 5.6% vs 64.0% ± 6.7%; log-rank P = .04). By multivariable Cox-hazard regression analysis, the independent predictor of 1-year mortality was genetic syndrome (hazard ratio, 3.54; 95% CI, 1.67-7.82; P < .001), whereas following a strategy of increasing weight from birth to surgery resulted in lower mortality (hazard ratio, 0.49; 95% CI, 0.24-0.90; P = .02). Conclusions A strategy of wait and grow for newborn infants with very low birth weight requiring heart surgery results in better survival than immediate surgery provided that the patient's condition allows for this waiting period.
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Affiliation(s)
- Soichiro Henmi
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Alyssia Venna
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Mitchell C. Haverty
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Rittal Mehta
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Manan Desai
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Aybala Tongut
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Can Yerebakan
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Mary T. Donofrio
- Department of Cardiology, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Ricardo A. Munoz
- Department of Cardiac Critical Care, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
| | - Yves d’Udekem
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
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A comparison of high-flow nasal cannula versus non-invasive positive pressure ventilation for respiratory support in infants following cardiac surgery. Cardiol Young 2023; 33:201-207. [PMID: 35236535 DOI: 10.1017/s1047951122000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Following cardiac surgery, infants often remain endotracheally intubated upon arrival to the cardiac ICU. High-flow nasal cannula and non-invasive positive pressure ventilation are used to support patients following extubation. There are limited data on the superiority of either mode to prevent extubation failure. METHODS We conducted a single-centre retrospective study for infants (<1 year) and/or <10 kg who underwent cardiac surgery between 3/2019-3/2020. Data included patient and clinical characteristics and operative variables. The study aimed to compare high-flow nasal cannula versus non-invasive positive pressure ventilation following extubation and their association with extubation failure. Secondarily, we examined risk factors associated with extubation failure. RESULTS There were 424 patients who met inclusion criteria, 320 (75%) were extubated to high-flow nasal cannula, 104 (25%) to non-invasive positive pressure ventilation, and 64 patients (15%) failed extubation. The high-flow nasal cannula group had lower rates of extubation failure (11%, versus 29%, p = 0.001). Infants failing extubation were younger and had higher STAT score (p < 0.05). Compared to high-flow nasal cannula, non-invasive positive pressure ventilation patients were at 3.30 times higher odds of failing extubation after adjusting for patient factors (p < 0.0001). CONCLUSIONS Extubation failure after cardiac surgery occurs in smaller, younger infants, and those with higher risk surgical procedures. Patients extubated to non-invasive positive pressure ventilation had 3.30 higher odds to fail extubation than patients extubated to high-flow nasal cannula. The optimal mode of respiratory support in this patient population is unknown.
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Henmi S, Essa Y, Öztürk M, Tongut A, Desai M, Yerebakan C, d'Udekem Y. Cardiovascular surgery in very low birth weight (≤1500 g) neonates. Eur J Cardiothorac Surg 2022; 63:6873741. [PMID: 36469322 DOI: 10.1093/ejcts/ezac552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/08/2022] [Accepted: 12/02/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Low birth weight and prematurity are known risks of increased morbidity and mortality with undergoing cardiovascular surgery. Our aim was to review the outcomes of very low birth weight (≤1500 g) patients who have undergone cardiovascular surgery. METHODS A retrospective review was performed for 32 very low birth weight (≤1500 g) patients who underwent cardiovascular surgery from 2004 to 2021 in our institution. RESULTS Fifteen patients weighting ≤1500 g at surgery (≤1500-g group) were compared to 17 patients born with a weigh of ≤1500 g and weighting between 1500 and 2500 g at surgery (>1500- to ≤2500-g group) in this study. In-hospital mortality was 33% (5/15) in the ≤1500-g group and 24% (4/17) in the >1500- to ≤2500-g group (P = 0.55). All patients with simple biventricular lesion survived following full repair. The occurrence of postoperative intracerebral haemorrhage was significantly higher in those operated at weight ≤1500 g than those weighting >1500 to ≤2500 g (40% vs 0%; P = 0.01). The 1- and 3-year survival rates were 66.0 ± 12.4% and 46.2 ± 14.8% in the ≤1500-g group and 76.5 ± 10.3% and 70.6 ± 11.1% in the >1500- to ≤2500-g group (log-rank P = 0.12). CONCLUSIONS Cardiac surgery for a very low birth weight neonate resulted in a high early and late mortality. Early surgery is only acceptable for simple biventricular lesions if needed. Delayed surgery seems to provide better long-term outcomes in patients with complex lesions. Alternative strategies for neonatal cardiopulmonary bypass should be investigated in patients with complex biventricular and single ventricular lesions.
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Affiliation(s)
- Soichiro Henmi
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Yasin Essa
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Mahmut Öztürk
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Aybala Tongut
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Manan Desai
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Can Yerebakan
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Yves d'Udekem
- Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC, USA
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Kwiatkowski DM, Ball MK, Savorgnan FJ, Allan CK, Dearani JA, Roth MD, Roth RZ, Sexson KS, Tweddell JS, Williams PK, Zender JE, Levy VY. Neonatal Congenital Heart Disease Surgical Readiness and Timing. Pediatrics 2022; 150:189888. [PMID: 36317977 DOI: 10.1542/peds.2022-056415d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- David M Kwiatkowski
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Molly K Ball
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Fabio J Savorgnan
- Department of Pediatrics, UT Southwestern, Children's Health, Dallas, Texas
| | - Catherine K Allan
- Department of Cardiology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo College of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Kristen S Sexson
- Department of Pediatrics, UT Southwestern, Children's Health, Dallas, Texas
| | - James S Tweddell
- Department of Surgery, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Patricia K Williams
- Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Jill E Zender
- Department of Pediatrics, UT Southwestern, Children's Health, Dallas, Texas
| | - Victor Y Levy
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, Texas
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Chowdhury D, Toms R, Brumbaugh JE, Bindom S, Ather M, Jaquiss R, Johnson JN. Evaluation and Management of Noncardiac Comorbidities in Children With Congenital Heart Disease. Pediatrics 2022; 150:189884. [PMID: 36317973 DOI: 10.1542/peds.2022-056415e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 02/25/2023] Open
Abstract
Outcomes for patients with neonatal heart disease are affected by numerous noncardiac and genetic factors. These can include neonatal concerns, such as prematurity and low birth weight, and congenital anomalies, such as airway, pulmonary, gastrointestinal, and genitourinary anomalies, and genetic syndromes. This section will serve as a summary of these issues and how they may affect the evaluation and management of a neonate with heart disease. These noncardiac factors are heavily influenced by conditions common to neonatologists, making a strong argument for multidisciplinary care with neonatologists, cardiologists, surgeons, anesthesiologists, and cardiovascular intensivists. Through this section and this project, we aim to facilitate a comprehensive approach to the care of neonates with congenital heart disease.
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Affiliation(s)
- Devyani Chowdhury
- Cardiology Care for Children, Lancaster, Pennsylvania Nemours Cardiac Center.,These two co-first authors contributed equally to this manuscript
| | - Rune Toms
- Division of Neonatal-Perinatal Medicine, Joe DiMaggio Children's Hospital, Hollywood, Florida.,These two co-first authors contributed equally to this manuscript
| | | | - Sharell Bindom
- Division of Neonatal-Perinatal Medicine, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Mishaal Ather
- Cardiology Care for Children, Lancaster, Pennsylvania Nemours Cardiac Center
| | - Robert Jaquiss
- Division of Pediatric and Congenital Cardiothoracic Surgery, Children's Medical Center, Dallas, Texas
| | - Jonathan N Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, Minnesota
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Zou L, Yu D, Wang R, Cun Y, Li Y, Wang Q, Shu Y, Mo X. Predictors of Low Cardiac Output Syndrome in Infants After Open-Heart Surgery. Front Pediatr 2022; 10:829731. [PMID: 35359906 PMCID: PMC8960261 DOI: 10.3389/fped.2022.829731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/04/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the predictors of low cardiac output syndrome (LCOS) in infants with congenital heart disease (CHD) after cardiopulmonary bypass (CPB). STUDY DESIGN A total of 217 infants were enrolled and classified according to whether they developed LCOS after cardiac surgery. Each infant's preoperative and intraoperative clinical variables were collected. RESULTS The incidence of LCOS was 28.11% in our study. The univariate analysis showed that the LCOS group was younger than the non-LCOS group (25.69 ± 25.01 days vs. 44.45 ± 26.97 days, P < 0.001), with a higher proportion of neonates (60.7 vs. 27.6%, P < 0.001) and a higher proportion of patients with a RACHS-1 score ≥4 (50.8 vs. 17.9%, P < 0.001). A lower weight (3.70 ± 0.74 vs. 4.23 ± 1.10 kg, P = 0.001), longer ACC time (61.96 ± 21.44 min vs. 41.06 ± 18.37 min, P < 0.001) and longer CPB time (131.54 ± 67.21 min vs. 95.78 ± 62.67 min, P < 0.001) were found in the LCOS group. The levels of free triiodothyronine (FT3) (4.55 ± 1.29 pmol/L vs. 5.18 ± 1.42 pmol/L, P = 0.003) and total triiodothyronine (TT3) (1.80 ± 0.56 nmol/L vs. 1.98 ± 0.54 nmol/L, P = 0.026) were also lower in the LCOS group. The multivariate binary logistic regression analysis and receiver operating characteristic (ROC) indicated that the ACC time, FT3 level and body weight were independent predictors of LCOS. CONCLUSIONS In our patient population, we first propose that preoperative FT3 can predict the occurrence of postoperative LCOS. ACC time, FT3 level and body weight are independent predictors of LCOS and maybe helpful in reducing the incidence of postoperative LCOS in the future.
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Affiliation(s)
- Liang Zou
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Di Yu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ruonan Wang
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yueshuang Cun
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yaping Li
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qingfeng Wang
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yaqin Shu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
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Dumitrascu Biris I, Mintoft A, Harris C, Rawn Z, Jheeta JS, Pushparajah K, Khan H, Fox G. Mortality and morbidity in preterm infants with congenital heart disease. Acta Paediatr 2022; 111:151-156. [PMID: 34655490 DOI: 10.1111/apa.16155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/20/2021] [Accepted: 10/14/2021] [Indexed: 11/28/2022]
Abstract
AIM To compare in-hospital mortality and rates of necrotising enterocolitis (NEC), sepsis, IVH and length of invasive respiratory support in preterm infants <36 weeks' gestation with congenital heart disease (CHD) to matched preterm infants without CHD in a single London centre over 13-year period. METHODS Single-centre retrospective case-control study over the 13-year period from May 2004 to May 2017. RESULTS Two hundred forty-seven preterm infants with CHD were matched to 494 infants without CHD. Patients with CHD had a significantly increased risk of in-hospital mortality compared to controls (OR 7.39 (95% CI 4.37-12.5); p < 0.001). Preterm infants with CHD had a higher risk of NEC (OR 2.42 (95% CI 1.32-4.45); p = 0.005), sepsis (OR 1.68 (95% CI 1.23-2.28); p = 0.001) and invasive respiratory support ≥28 days (OR 2.34 (95% CI 1.19-4.58); p = 0.017). Risk of IVH was lower in preterm infants with CHD (OR 0.22 (95% CI 0.11-0.42); p = 0.0001). CONCLUSION Preterm birth with CHD is associated with a higher risk of in-hospital mortality, NEC, sepsis and prolonged invasive respiratory support, but a lower risk of IVH compared to matched controls. In-hospital mortality remains high in moderate-to-late preterm infants with CHD.
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Affiliation(s)
- Ioana Dumitrascu Biris
- Department of Neonatology Guy’s and St. Thomas NHS Foundation Trust London UK
- Department of Paediatric Congenital Heart Disease Evelina London Children's Hospital Guy's and St Thomas’ NHS Foundation Trust London UK
| | - Alison Mintoft
- Department of Neonatology Guy’s and St. Thomas NHS Foundation Trust London UK
| | - Christopher Harris
- Department of Neonatology Guy’s and St. Thomas NHS Foundation Trust London UK
- King’s College Hospital NHS Foundation Trust London UK
| | - Zeshan Rawn
- Department of Neonatology Guy’s and St. Thomas NHS Foundation Trust London UK
| | | | - Kuberan Pushparajah
- Department of Paediatric Congenital Heart Disease Evelina London Children's Hospital Guy's and St Thomas’ NHS Foundation Trust London UK
| | - Hammad Khan
- Department of Neonatology Guy’s and St. Thomas NHS Foundation Trust London UK
| | - Grenville Fox
- Department of Neonatology Guy’s and St. Thomas NHS Foundation Trust London UK
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Kim M, Okunowo O, Ades AM, Fuller S, Rintoul NE, Naim MY. Single-Center Comparison of Outcomes Following Cardiac Surgery in Low Birth Weight and Standard Birth Weight Neonates. J Pediatr 2021; 238:161-167.e1. [PMID: 34214588 DOI: 10.1016/j.jpeds.2021.06.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/19/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare outcomes between low birth weight (LBW; <2.5 kg) and standard birth weight neonates undergoing cardiac surgery. STUDY DESIGN A single-center retrospective study of neonates undergoing cardiac surgery with cardiopulmonary bypass from 2012 to 2018. LBW neonates were 1:2 propensity score-matched to standard birth weight neonates (n = 93 to n = 186) using clinical characteristics. The primary and secondary outcomes were survival to hospital discharge and postoperative complications, respectively. After matching, regression analyses were conducted to compare outcomes. RESULTS The LBW group had a higher proportion of premature neonates than the standard birth weight group (60% vs 8%; P < .01) and were less likely to survive to hospital discharge (88% vs 95%; OR, 0.39; 95% CI, 0.15-0.97). There was no difference in unplanned cardiac reoperations or catheter-based interventions, cardiac arrest, extracorporeal membrane oxygenation, infection, and end-organ complications between the groups. Among LBW infants, survival was improved at weight >2 kg. CONCLUSIONS LBW is a risk factor for decreased survival. LBW neonates weighing >2 kg have survival comparable to those weighing >2.5 kg.
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Affiliation(s)
- Minso Kim
- Division of Newborn Medicine, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York, NY.
| | - Oluwatimilehin Okunowo
- Data Science & Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Anne M Ades
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Natalie E Rintoul
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Maryam Y Naim
- Division of Cardiac Critical Care, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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9
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Qureshi AM, Caldarone CA, Romano JC, Chai PJ, Mascio CE, Glatz AC, Petit CJ, McCracken CE, Kelleman MS, Nicholson GT, Meadows JJ, Zampi JD, Shahanavaz S, Law MA, Batlivala SP, Goldstein BH. Comparison of management strategies for neonates with symptomatic tetralogy of Fallot and weight <2.5 kg. J Thorac Cardiovasc Surg 2021; 163:192-207.e3. [PMID: 33726912 DOI: 10.1016/j.jtcvs.2021.01.100] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To compare management strategies for neonates <2.5 kg with tetralogy of Fallot and symptomatic cyanosis who either undergo staged repair (SR) (initial palliation followed by later complete repair) or primary repair (PR). METHODS Consecutive neonates with tetralogy of Fallot and symptomatic cyanosis weighing <2.5 kg at initial intervention and between 2005 and 2017 were retrospectively reviewed from the Congenital Cardiac Research Collaborative. Primary outcome was mortality and secondary outcomes included component (eg, initial palliation, complete repair, or primary repair) and cumulative (SR: initial palliation followed by later complete repair) hospital and intensive care unit lengths of stay, durations of ventilation, inotrope use, cardiopulmonary bypass time, procedural complications, and reintervention. Outcomes were compared with propensity score adjustments with PR as the reference group. RESULTS The cohort included 76 SR (initial palliation: 53 surgical and 23 transcatheter) and 44 PR patients. The observed risk of overall mortality was similar between SR and PR groups (15.8% vs 18.2%: P = .735). The adjusted hazard of mortality remained similar between groups overall (hazard ratio, 0.59; 95% confidence interval, 0.26-1.36; P = .214), as well as during short-term (<4 months: hazard ratio, 0.37; 95% confidence interval, 0.13-1.09; P = .071) and midterm (>4 months: hazard ratio, 1.32; 95% confidence interval, 0.30-5.79; P = .717) follow-up. Reintervention in the first 18 months was common in both groups (53.2% vs 48.4%; hazard ratio, 1.69; 95% confidence interval, 0.96-2.28; P = .072). Adjusted procedural complications and neonatal morbidity burden were overall lower in the SR group. Cumulative secondary outcome burdens largely favored the PR group. CONCLUSIONS In this study comparing SR and PR treatment strategies for neonates with tetralogy of Fallot and symptomatic cyanosis and weight <2.5 kg, mortality and reintervention burden was highly independent of treatment strategy. Other potential advantages were observed with each approach.
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Affiliation(s)
- Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Houston, Tex; Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
| | - Christopher A Caldarone
- Congenital Heart Surgery, Texas Children's Hospital, Houston, Tex; Department of Surgery, Baylor College of Medicine, Houston, Tex
| | | | - Paul J Chai
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | | | - Andrew C Glatz
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Christopher J Petit
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Courtney E McCracken
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Michael S Kelleman
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | | | | | | | | | - Mark A Law
- University of Alabama at Birmingham, Birmingham, Ala
| | - Sarosh P Batlivala
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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10
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Zurakowski D, Jonas RA. The many factors leading to resurgence of the Blalock shunt for tetralogy. J Thorac Cardiovasc Surg 2021; 161:396-399. [DOI: 10.1016/j.jtcvs.2020.03.172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 02/07/2023]
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11
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Cheung PY, Hajihosseini M, Dinu IA, Switzer H, Joffe AR, Bond GY, Robertson CMT. Outcomes of Preterm Infants With Congenital Heart Defects After Early Surgery: Defining Risk Factors at Different Time Points During Hospitalization. Front Pediatr 2021; 8:616659. [PMID: 33585367 PMCID: PMC7876369 DOI: 10.3389/fped.2020.616659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/11/2020] [Indexed: 01/28/2023] Open
Abstract
Background: Compared with those born at term gestation, infants with complex congenital heart defects (CCHD) who were delivered before 37 weeks gestational age and received neonatal open-heart surgery (OHS) have poorer neurodevelopmental outcomes in early childhood. We aimed to describe the growth, disability, functional, and neurodevelopmental outcomes in early childhood of preterm infants with CCHD after neonatal OHS. Prediction models were evaluated at various timepoints during hospitalization which could be useful in the management of these infants. Study Design: We studied all preterm infants with CCHD who received OHS within 6 weeks of corrected age between 1996 and 2016. The Western Canadian Complex Pediatric Therapies Follow-up Program completed multidisciplinary comprehensive neurodevelopmental assessments at 2-year corrected age at the referral-site follow-up clinics. We collected demographic and acute-care clinical data, standardized age-appropriate outcome measures including physical growth with calculated z-scores; disabilities including cerebral palsy, visual impairment, permanent hearing loss; adaptive function (Adaptive Behavior Assessment System-II); and cognitive, language, and motor skills (Bayley Scales of Infant and Toddler Development-III). Multiple variable logistic or linear regressions determined predictors displayed as Odds Ratio (OR) or Effect Size (ES) with 95% confidence intervals. Results: Of 115 preterm infants (34 ± 2 weeks gestation, 2,339 ± 637 g, 64% males) with CCHD and OHS, there were 11(10%) deaths before first discharge and 21(18%) deaths by 2-years. Seven (6%) neonates had cerebral injuries, 7 had necrotizing enterocolitis; none had retinopathy of prematurity. Among 94 survivors, 9% had cerebral palsy and 6% had permanent hearing loss, with worse outcomes in those with syndromic diagnoses. Significant predictors of mortality included birth weight z-score [OR 0.28(0.11,0.72), P = 0.008], single-ventricle anatomy [OR 5.92(1.31,26.80), P = 0.021], post-operative ventilation days [OR 1.06(1.02,1.09), P = 0.007], and cardiopulmonary resuscitation [OR 11.58 (1.97,68.24), P = 0.007]; for adverse functional outcome in those without syndromic diagnoses, birth weight 2,000-2,499 g [ES -11.60(-18.67, -4.53), P = 0.002], post-conceptual age [ES -0.11(-0.22,0.00), P = 0.044], post-operative lowest pH [ES 6.75(1.25,12.25), P = 0.017], and sepsis [ES -9.70(-17.74, -1.66), P = 0.050]. Conclusions: Our findings suggest preterm neonates with CCHD and early OHS had significant mortality and morbidity at 2-years and were at risk for cerebral palsy and adverse neurodevelopment. This information may be important for management, parental counseling and the decision-making process.
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Affiliation(s)
- Po-Yin Cheung
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- NICU, Northern Alberta Neonatal Program of Alberta Health Services, Edmonton, AB, Canada
| | | | - Irina A. Dinu
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | - Ari R. Joffe
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- PICU Stollery Children's Hospital, Edmonton, AB, Canada
| | - Gwen Y. Bond
- Complex Pediatric Therapies Developmental Assessment Clinic at the Glenrose Rehabilitation Hospital of Alberta Health Services, Edmonton, AB, Canada
| | - Charlene M. T. Robertson
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Complex Pediatric Therapies Developmental Assessment Clinic at the Glenrose Rehabilitation Hospital of Alberta Health Services, Edmonton, AB, Canada
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Valderrama P, Garay F, Springmüller D, Briones Y, Aguirre D, González R, Becker P, Zamora G, Sánchez L, Castillo G, Palominos G, Cárdenas L. Initial Experience in Chile with Stent Implantation in the Right Ventricle Outflow Tract in High-Risk Patients with Tetralogy of Fallot. Pediatr Cardiol 2020; 41:837-842. [PMID: 32107585 DOI: 10.1007/s00246-020-02321-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/17/2020] [Indexed: 11/25/2022]
Abstract
Tetralogy of Fallot (ToF) treatment is difficult in patients with surgical risk factors or unfavorable anatomy. Stent implantation in the right ventricular outflow tract (RVOT) is an option for these patients. We report our initial experience in Chile with RVOT stenting in patients with ToF. Retrospective and descriptive study conducted in three pediatric cardiovascular centers in Chile between 2012 and 2015, including all ToF patients with stent in the RVOT as first procedure. Clinical records, echocardiographic, interventional, and surgical reports were reviewed for demographics and information of RVOT and pulmonary arteries. 12 newborns with ToF were included (75% female). Median age was 20 days (1-70) and mean weight was 2178 g (1400-3414). Saturations increased after the procedure from 74.3% (55-88) to 88.5% (80-98%), (p < 0.01). No complications or mortality were related to interventions. Follow-up was 11 months (7-36). Median right and left pulmonary arteries Z-score increased from - 4.0 (- 5.2 to - 0.3) and - 1.5 (- 4.8 to - 0.26) to + 0.53 (0.0 to 2.2) and + 1.1 (0.5 to 2.9), (p < 0.05), respectively. Nakata index increased from 63 mm2/mm2 (35 to 143) to 162 mm2/mm2 (107 to 197), (p < 0.05). Surgical repair was performed at a median of 4 months (2-7). Transannular patch repair was necessary in all patients and there was no surgical mortality. RVOT stenting is a safe and useful option for patients with ToF and surgical risk factors or unfavorable anatomy. It increases the pulmonary blood flow, improving saturation and pulmonary artery growth as a bridge for surgical repair.
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Affiliation(s)
- Paulo Valderrama
- Department of Pediatric Cardiology, Respiratory and Cardiovascular Diseases, Division of Pediatrics, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Francisco Garay
- Department of Pediatric Cardiology, Respiratory and Cardiovascular Diseases, Division of Pediatrics, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Daniel Springmüller
- Department of Pediatric Cardiology, Respiratory and Cardiovascular Diseases, Division of Pediatrics, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Yeny Briones
- Cardiovascular Center Dr. Luis Calvo Mackenna Hospital, Chilean Public Health Network, Av. Antonio Varas Nº 360, 7500539, Santiago, Chile
| | - Daniel Aguirre
- Cardiovascular Center Dr. Roberto del Río Hospital, Chilean Public Health Network, Santiago, Chile
| | - Rodrigo González
- Department of Pediatric Cardiology, Respiratory and Cardiovascular Diseases, Division of Pediatrics, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Pedro Becker
- Department of Pediatric Cardiology, Respiratory and Cardiovascular Diseases, Division of Pediatrics, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Guillermo Zamora
- Cardiovascular Center Dr. Luis Calvo Mackenna Hospital, Chilean Public Health Network, Av. Antonio Varas Nº 360, 7500539, Santiago, Chile
| | - Luis Sánchez
- Cardiovascular Center Dr. Luis Calvo Mackenna Hospital, Chilean Public Health Network, Av. Antonio Varas Nº 360, 7500539, Santiago, Chile
| | - Gabriel Castillo
- Cardiovascular Center Dr. Roberto del Río Hospital, Chilean Public Health Network, Santiago, Chile
| | - Gilberto Palominos
- Cardiovascular Center Dr. Roberto del Río Hospital, Chilean Public Health Network, Santiago, Chile
| | - Luis Cárdenas
- Cardiovascular Center Dr. Luis Calvo Mackenna Hospital, Chilean Public Health Network, Av. Antonio Varas Nº 360, 7500539, Santiago, Chile.
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Lu C, Yu L, Wei J, Chen J, Zhuang J, Wang S. Predictors of postoperative outcomes in infants with low birth weight undergoing congenital heart surgery: a retrospective observational study. Ther Clin Risk Manag 2019; 15:851-860. [PMID: 31371972 PMCID: PMC6628950 DOI: 10.2147/tcrm.s206147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/27/2019] [Indexed: 11/23/2022] Open
Abstract
Background Despite improvements in neonatal cardiac surgery and postoperative care, hospitalized death for infants with low birth weight remains high. Objective This study sought to identify predictors of postoperative outcomes in low-birth-weight infants undergoing congenital heart surgery and establish nomograms to predict postoperative intensive-care unit (ICU) stay. Methods From June 2009 to June 2018, a retrospective review of 114 infants with low birth weight (≤2.5 kg) undergoing congenital heart surgery was conducted at Guangdong Provincial People’s Hospital. Purely surgical ligation of patent ductus arteriosus was excluded from this study. A total of 26 clinical variables were chosen for univariate, multivariate, and Cox regression analysis, and 14 variables were analyzed as predictors of postoperative outcomes. Nomograms were established to predict risk of postoperative cardiac ICU (CICU) stay, postoperative neonatal ICU (NICU) stay, and total ICU length of stay in infants with cardiac diseases. Results Two variables were independent predictors in multiple logistic regression analysis of hospitalized death: operation weight and Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery (STAT) risk categories. Six variables were independent predictors in the Cox model of postoperative ICU length of stay, including sex, prematurity, birth weight, preoperative stay time in NICU, diagnostic classification, and STAT risk categories. We calculated concordance-index values to estimate the discriminative ability of models of risk of postoperative CICU stay, postoperative NICU stay, and total ICU length of stay, with values of 0.758 (95% CI 0.696–0.820), 0.604 (95% CI 0.525–0.682), and 0.716 (95% CI 0.657–0.776), which indicated the possibility of true-positive results. Conclusion Our findings might help clinicians predict postoperative outcomes and optimize therapeutic strategies.
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Affiliation(s)
- Chao Lu
- Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Lina Yu
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Jinfeng Wei
- Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Jimei Chen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Sheng Wang
- Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
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Bansal N, Balakrishnan PL, Aggarwal S. Prostaglandin Infusion in Neonate With Severe Coarctation of the Aorta With Closed Ductus Arteriosus-A Case Report and Review of the Literature. World J Pediatr Congenit Heart Surg 2019; 11:NP239-NP243. [PMID: 31010402 DOI: 10.1177/2150135118799635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report the case of a premature newborn diagnosed with coarctation of the aorta after spontaneous closure of ductus arteriosus who was successfully managed with prostaglandin E1 infusion until surgical repair could be performed. This case, together with a review of the literature, suggests an important role for prostaglandin in the management of coarctation even in the absence of a patent ductus arteriosus. The putative mechanism for the utility of prostaglandin infusion is that it may relieve the obstruction in neonates with severe coarctation by not only opening of the ductus but, in select cases, relaxing the ductal tissue encircling the aortic isthmus region. We also found a possible dose dependence of the efficacy of the prostaglandin infusion when the ductus is closed.
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Affiliation(s)
- Neha Bansal
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Preetha L Balakrishnan
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Sanjeev Aggarwal
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
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15
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Nokhrin AV, Tarasov RS, Mukhamadiyarov RA, Shishkova DK, Kutikhin AG, Dzyuman AN, Khlusov IA, Barbarash LS. Two‐stage approach for surgical treatment of tetralogy of Fallot in underweight children: Clinical and morphological outcomes. J Card Surg 2019; 34:293-299. [DOI: 10.1111/jocs.14031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/14/2019] [Accepted: 02/26/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Andrey V. Nokhrin
- Division of Experimental and Clinical CardiologyResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovo Russian Federation
| | - Roman S. Tarasov
- Division of Experimental and Clinical CardiologyResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovo Russian Federation
| | - Rinat A. Mukhamadiyarov
- Division of Experimental and Clinical CardiologyResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovo Russian Federation
| | - Daria K. Shishkova
- Division of Experimental and Clinical CardiologyResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovo Russian Federation
| | - Anton G. Kutikhin
- Division of Experimental and Clinical CardiologyResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovo Russian Federation
| | - Anna N. Dzyuman
- Department of Morphology and General PathologySiberian State Medical UniversityTomsk Russian Federation
| | - Igor A. Khlusov
- Department of Morphology and General PathologySiberian State Medical UniversityTomsk Russian Federation
- Department of Immunology and Cell BiotechnologyImmanuel Kant Baltic Federal UniversityKaliningrad Russian Federation
| | - Leonid S. Barbarash
- Division of Experimental and Clinical CardiologyResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovo Russian Federation
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16
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Overman DM. The data show it: Size matters. J Thorac Cardiovasc Surg 2019; 157:1144-1145. [PMID: 33197995 DOI: 10.1016/j.jtcvs.2018.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/17/2022]
Affiliation(s)
- David M Overman
- Division of Cardiac Surgery, The Children's Heart Clinic, Minneapolis, Minn; Division of Cardiovascular Surgery, Children's Minnesota, Minneapolis, Minn.
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Liu MY, Zielonka B, Snarr BS, Zhang X, Gaynor JW, Rychik J. Longitudinal Assessment of Outcome From Prenatal Diagnosis Through Fontan Operation for Over 500 Fetuses With Single Ventricle-Type Congenital Heart Disease: The Philadelphia Fetus-to-Fontan Cohort Study. J Am Heart Assoc 2018; 7:e009145. [PMID: 30371305 PMCID: PMC6404885 DOI: 10.1161/jaha.118.009145] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/27/2018] [Indexed: 11/24/2022]
Abstract
Background Prenatal diagnosis of single ventricle-type congenital heart disease is associated with improved clinical courses. Prenatal counseling allows for optimal delivery preparations and opportunity for prenatal intervention. Expectant parents frequently ask what the likelihood of survival through staged palliation is and the factors that influence outcome. Our goal was specifically to quantify peri- and postnatal outcomes in this population. Methods and Results We identified all patients with a prenatal diagnosis of single ventricle-type congenital heart disease presenting between July 2004 and December 2011 at our institution. Maternal data, fetal characteristics, and data from the postnatal clinical course were collected for each patient. Kaplan-Meier curves and multivariate analysis with logistic regression were used to evaluate variables associated with decreased transplant-free survival. Five hundred two patients were identified, consisting of 381 (76%) right ventricle- and 121 left ventricle-dominant lesions. After prenatal diagnosis, 42 patients did not follow up at our center; 79 (16%) chose termination of pregnancy, and 11 had intrauterine demise with 370 (74%) surviving to birth. Twenty-two (6%) underwent palliative care at birth. Among 348 surviving to birth with intention to treat, 234 (67%) survived to at least 6 months post-Fontan palliation. Presence of fetal hydrops, right ventricle dominance, presence of extracardiac anomalies, and low birthweight were significantly associated with decreased transplant-free survival. Conclusions In patients with a prenatal diagnosis of single ventricle-type congenital heart disease and intention to treat, 67% survive transplant-free to at least 6 months beyond Fontan operation. An additional 5% survive to 4 years of age without transplant or Fontan completion. Fetuses with right ventricle-dominant lesions, extracardiac anomalies, hydrops, or low birthweights have decreased transplant-free survival.
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Affiliation(s)
- Michael Y. Liu
- Divisions of Cardiology and Cardiothoracic SurgeryThe Children's Hospital of Philadelphia, PhiladelphiaPA
- Departments of Pediatrics and SurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - Benjamin Zielonka
- Divisions of Cardiology and Cardiothoracic SurgeryThe Children's Hospital of Philadelphia, PhiladelphiaPA
- Departments of Pediatrics and SurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - Brian S. Snarr
- Divisions of Cardiology and Cardiothoracic SurgeryThe Children's Hospital of Philadelphia, PhiladelphiaPA
- Departments of Pediatrics and SurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - Xuemei Zhang
- Divisions of Cardiology and Cardiothoracic SurgeryThe Children's Hospital of Philadelphia, PhiladelphiaPA
- Departments of Pediatrics and SurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - J. William Gaynor
- Divisions of Cardiology and Cardiothoracic SurgeryThe Children's Hospital of Philadelphia, PhiladelphiaPA
- Departments of Pediatrics and SurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - Jack Rychik
- Divisions of Cardiology and Cardiothoracic SurgeryThe Children's Hospital of Philadelphia, PhiladelphiaPA
- Departments of Pediatrics and SurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
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Seckeler MD, White SC, Fox KA. Increased risk of intraventricular hemorrhage in low birth weight infants with aortic coarctation. J Matern Fetal Neonatal Med 2018; 33:1273-1275. [PMID: 30149745 DOI: 10.1080/14767058.2018.1517319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: To determine if there is an association between aortic coarctation (CoA) and intraventricular hemorrhage (IVH) in low birth weight (LBW) infants that may justify earlier intervention. While there is an increasing number of reports of successful early CoA intervention in LBW infants, there are no data to justify this approach.Material and methods: Retrospective review of the University Health System Consortium Clinical Data Base/Resource Manager, a national hospital discharge database. LBW (≤2 kg) infants, with and without IVH and isolated CoA were identified; IVH was stratified into low (grade 1 or 2) and high (grade 3 or 4) severity. Odds ratios were calculated for any, low and high-grade IVH with CoA.Results: Forty-six thousand and twenty LBW infants were identified; 3716 (8.1%) had IVH, 3001 (81%) with low, and 724 (19%) with high severity. Sixty-four infants had CoA, 13 had associated IVH (10 with low and three with high severity). The odds ratio for any IVH with CoA was 2.91 (95% CI 1.58-5.35), low severity 2.77 (95% CI 1.41-5.46) and high severity 3.45 (95% CI 1.07-11.07).Conclusions: In conclusion, this large retrospective database review found that LBW infants with CoA may be at increased risk of IVH. Further study is needed to determine if earlier catheter- or surgical-based intervention for CoA could reduce the risk of IVH in this population.
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Affiliation(s)
- Michael D Seckeler
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, AZ, USA
| | - Shelby C White
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, AZ, USA
| | - Kenneth A Fox
- Department of Surgery, Section of Congenital Heart Surgery, University of Arizona, Tucson, AZ, USA
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19
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Salna M, Chai PJ, Kalfa D, Nakamura Y, Krishnamurthy G, Quaegebeur JM, Najjar M, Shah A, Levasseur S, Anderson BR, Bacha EA. Outcomes of the Arterial Switch Operation in ≤2.5-kg Neonates. Semin Thorac Cardiovasc Surg 2018; 31:488-493. [PMID: 29621622 DOI: 10.1053/j.semtcvs.2018.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 11/11/2022]
Abstract
Although low birth weight is a known risk factor for mortality in congenital heart lesions and may consequently delay surgical repair, outcomes in low-weight neonates undergoing the arterial switch operation (ASO) have not been well described. Our objective was to assess the safety of this procedure in infants weighing ≤2.5 kg at the time of surgery. We retrospectively analyzed outcomes for all neonates undergoing the ASO at our institution from 2005 to 2015. Our primary outcome of interest was major morbidity or operative mortality, assessed as a composite outcome. From 2005 to 2015, 217 neonates underwent the ASO, with 31 (14%) weighing ≤2.5 kg at the date of surgery, and 8 weighing <2.0 kg. Neonates weighing ≤2.5 kg were more likely to be premature than those weighing >2.5 kg, but there was no difference in the age at operation between these groups. Overall, 32 infants experienced a major morbidity or mortality, including 37.5% (n = 3) weighing <2.0 kg, 8.7% (n = 2) weighing 2.0-2.5 kg, and 14.5% (n = 7) weighing >2.5 kg (P = 0.141). One infant weighing <2.0 kg (1.1 kg) and 4 infants weighing >2.5 kg died. In multivariable models, odds of major morbidity or mortality were significantly higher for infants weighing <2 kg compared with infants weighing >2.5 kg (odds ratio 3.93, 95% confidence interval 1.04-14.85, P = 0.044), but there was no difference between infants weighing 2.0-2.5 kg and those weighing >2.5 kg (P = 0.225). The ASO can be performed safely in 2.0- to 2.5-kg neonates and yields results comparable with higher weight infants. Imposed delays for corrective surgery may not be necessary for these low-weight infants with transposition of the great arteries.
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Affiliation(s)
- Michael Salna
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Paul J Chai
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - David Kalfa
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Yuki Nakamura
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ganga Krishnamurthy
- Division of Neonatology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Jan M Quaegebeur
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Marc Najjar
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Amee Shah
- Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Stephanie Levasseur
- Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Brett R Anderson
- Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Emile A Bacha
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
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20
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Alarcon Manchego P, Cheung M, Zannino D, Nunn R, D'Udekem Y, Brizard C. Audit of Cardiac Surgery Outcomes for Low Birth Weight and Premature Infants. Semin Thorac Cardiovasc Surg 2018; 30:71-78. [DOI: 10.1053/j.semtcvs.2018.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 11/11/2022]
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21
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Desai J, Aggarwal S, Lipshultz S, Agarwal P, Yigazu P, Patel R, Seals S, Natarajan G. Surgical Interventions in Infants Born Preterm with Congenital Heart Defects: An Analysis of the Kids' Inpatient Database. J Pediatr 2017; 191:103-109.e4. [PMID: 28964428 DOI: 10.1016/j.jpeds.2017.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/16/2017] [Accepted: 07/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate short-term outcomes in infants born preterm with congenital heart defects (CHDs) and the factors associated with surgery, survival, and length of hospitalization in this population. STUDY DESIGN We analyzed data from infants born preterm (gestational age <37 weeks) enrolled in the multicenter Kids' Inpatient Database of the Healthcare Cost and Utilization Project who were admitted to the hospital within 30 days after birth. Infants with atrial septal defects were excluded. RESULTS Of 1 429 762 enrolled infants born preterm, 27 434 (2.0%) with CHDs were included. Overall survival to discharge was 90.5%; 74.0% among infants with critical CHDs and 45.7% among infants with hypoplastic left heart syndrome. Cardiac surgeries were performed in 12.2% of all infants born preterm. Rates of surgical intervention for infants with critical CHDs were lower for very low birth weight (≤1.5 kg) vs larger infants >1.5 kg (27% vs 44%), and only 6.3% of infants born with very low birth weight underwent surgeries in Risk-adjustment for Congenital Heart Surgery categories 4 or greater. Greater birth weight, left-sided lesions, care at children's hospitals, and absence of trisomies were associated with a greater likelihood of surgery. Birth weight <2 kg, nonwhite race, trisomy syndromes, prematurity-related morbidities, and Risk-adjustment for Congenital Heart Surgery category 4 or greater were independent predictors of mortality. Birth weight <2 kg, Risk-adjustment for Congenital Heart Surgery category, morbidities, and sidedness of lesion predicted length of stay. CONCLUSIONS The high survival rates of infants born preterm with CHDs suggests that a cautiously optimistic approach to surgery may be warranted in all but the most immature infants with the greatest-risk conditions.
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Affiliation(s)
- Jagdish Desai
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS; Division of Neonatology, Children's Hospital of Michigan, Wayne State University, Detroit, MI.
| | - Sanjeev Aggarwal
- Division of Pediatric Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - Steven Lipshultz
- Division of Pediatric Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - Prashant Agarwal
- Division of Neonatology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - Paulos Yigazu
- Division of Neonatology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - Riddhiben Patel
- Division of Child Neurology, University of Mississippi Medical Center, Jackson, MS
| | - Samantha Seals
- Center of Biostatistics & Bioinformatics, University of Mississippi Medical Center, Jackson, MS
| | - Girija Natarajan
- Division of Neonatology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
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Abstract
BACKGROUND Numerous advances in surgical techniques and understanding of single-ventricle physiology have resulted in improved survival. We sought to determine the influence of various demographic, perioperative, and patient-specific factors on the survival of single-ventricle patients following stage 1 palliation at our institution. METHODS We conducted a retrospective study of all single-ventricle patients who had undergone staged palliation at our institution over an 8-year period. Data were collected from the Society of Thoracic Surgeons Congenital Heart Surgery database and from patient charts. Information on age, weight at stage 1 palliation, prematurity, genetic abnormalities, non-cardiac anomalies, ventricular dominance, and type of palliation was collected. Information on mortality and unplanned reinterventions was also collected. RESULTS A total of 72 patients underwent stage 1 palliation over an 8-year period. There were 12 deaths before and one death after stage 2 palliation. There was no hospital mortality following Glenn or Fontan procedures. On univariate analysis, low weight at the time of stage 1 palliation and prematurity were found to be risk factors for mortality following stage 1 palliation. However, multivariable Cox regression analysis revealed weight at stage 1 palliation to be a strong predictor of mortality. The type of stage 1 palliation did not have any influence on the outcome. No difference in survival was noted following the Glenn procedure. CONCLUSION Low weight has a deleterious impact on survival following stage 1 palliation. This is mitigated by stage 2 palliation. The type of stage 1 palliation itself has no bearing on the outcome.
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23
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Laas E, Lelong N, Ancel PY, Bonnet D, Houyel L, Magny JF, Andrieu T, Goffinet F, Khoshnood B. Impact of preterm birth on infant mortality for newborns with congenital heart defects: The EPICARD population-based cohort study. BMC Pediatr 2017; 17:124. [PMID: 28506266 PMCID: PMC5433049 DOI: 10.1186/s12887-017-0875-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background Congenital heart defects (CHD) and preterm birth (PTB) are major causes of infant mortality. However, limited data exist on risk of mortality associated with PTB for newborns with CHD. Our objective was to assess impact of PTB on risk of infant mortality for newborns with CHD, while taking into account the role of associated anomalies and other potentially confounding factors. Methods We used data on 2172 live births from a prospective population-based cohort study of CHD (the EPICARD Study) and compared neonatal, post-neonatal and overall infant mortality for infants born at <32, 32–34 and 35–36 weeks vs. those born at term (37–41 weeks). Results Preterm newborns had a 3.8-fold higher risk of infant death (17.9%) than term newborns (4.7%), RR 3.8, 95%CI 2.7–5.2; the risk associated with PTB was more than four-fold higher for neonatal (RR 4.3, 95% CI 2.9–6.6) and three-fold higher for post-neonatal deaths (RR 3.0, 95% CI 1.7–5.2). Survival analysis showed that newborns <35 weeks had a higher risk of mortality, which decreased but persisted after exclusion of associated anomalies and adjustment for potential confounders. Conclusions Preterm birth is associated with an approximately four-fold higher risk of infant mortality for newborns with CHD. This excess risk appears to be mostly limited to newborns <35 weeks of gestation and is disproportionately due to early deaths.
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Affiliation(s)
- Enora Laas
- Obstetrical, perinatal and pediatric epidemiology research team, Center for biostatistics and epidemiology, INSERM U1153, Maternité de Port-Royal, 6ème étage, 53 av. de l'Observatoire, 75014, Paris, France
| | - Nathalie Lelong
- Obstetrical, perinatal and pediatric epidemiology research team, Center for biostatistics and epidemiology, INSERM U1153, Maternité de Port-Royal, 6ème étage, 53 av. de l'Observatoire, 75014, Paris, France
| | - Pierre-Yves Ancel
- Obstetrical, perinatal and pediatric epidemiology research team, Center for biostatistics and epidemiology, INSERM U1153, Maternité de Port-Royal, 6ème étage, 53 av. de l'Observatoire, 75014, Paris, France
| | - Damien Bonnet
- Centre de référence M3C-Necker, Université Paris Descartes, 140 rue de Sèvres, 75015, Paris, France
| | - Lucile Houyel
- Service de chirurgie des cardiopathies congénitales, Hôpital Marie Lannelongue, 133, avenue de la Résistance, 92350, Le Plessis Robinson, France
| | - Jean-François Magny
- Service de pédiatrie et réanimation néonatales CHU Necker Enfants Malades, Paris, France
| | - Thibaut Andrieu
- Obstetrical, perinatal and pediatric epidemiology research team, Center for biostatistics and epidemiology, INSERM U1153, Maternité de Port-Royal, 6ème étage, 53 av. de l'Observatoire, 75014, Paris, France
| | - François Goffinet
- Obstetrical, perinatal and pediatric epidemiology research team, Center for biostatistics and epidemiology, INSERM U1153, Maternité de Port-Royal, 6ème étage, 53 av. de l'Observatoire, 75014, Paris, France.,Maternité Port Royal, 53 avenue de l'Observatoire, 75014, Paris, France
| | - Babak Khoshnood
- Obstetrical, perinatal and pediatric epidemiology research team, Center for biostatistics and epidemiology, INSERM U1153, Maternité de Port-Royal, 6ème étage, 53 av. de l'Observatoire, 75014, Paris, France.
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Fricke TA, Bulstra AE, Loyer BR, Weintraub RG, d'Udekem Y, Brizard CP, Konstantinov IE. Outcomes of the Arterial Switch Operation in Children Less Than 2.5 Kilograms. Ann Thorac Surg 2017; 103:840-844. [DOI: 10.1016/j.athoracsur.2016.11.079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/21/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
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Miura S, Hamamoto N, Osaki M, Nakano S, Miyakoshi C. Extubation Failure in Neonates After Cardiac Surgery: Prevalence, Etiology, and Risk Factors. Ann Thorac Surg 2016; 103:1293-1298. [PMID: 27720369 DOI: 10.1016/j.athoracsur.2016.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/20/2016] [Accepted: 08/01/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The purpose of this study was to explore the prevalence, etiology, and risk factors of extubation failure (EF) in post-cardiac surgery neonates. METHODS Neonates (30 days old or younger) who underwent cardiac surgery and were admitted to the cardiac intensive care unit between September 2010 and February 2016 were included. The prevalence and etiology of EF, defined as reintubation within 48 hours, were reviewed. Demographic, operative, and perioperative data were retrospectively collected. Multiple logistic regression models were constructed to identify the risk factors for EF. RESULTS The median age at surgery was 10 days. Extubation failure occurred in 25 of 156 cases (16.0%; 95% confidence interval: 10.6% to 22.7%), because of respiratory dysfunction (n = 16), hemodynamic instability (n = 4), upper airway obstruction (n = 4), or gastrointestinal bleeding (n = 1). Subsequent extubations were successful in 17 cases (68%) because of medical optimization of the causes of reintubation. The remaining 8 cases needed surgical reintervention, including tracheostomy and cardiac surgery. The inhospital mortality rate was 2.6%. In a bivariate analysis, younger age, airway diseases, ventilation before surgery, prolonged mechanical ventilation, and delayed sternal closure were associated with EF. The multivariable analysis identified airway diseases (adjusted odds ratio 18.2, 95% confidence interval: 3.8 to 88.6, p = 0.0003) and mechanical ventilation longer than 7 days (adjusted odds ratio 8.2, 95% confidence interval: 1.9 to 34.9, p = 0.0046) as risk factors for EF. CONCLUSIONS The prevalence of EF is relatively high in neonatal cardiac surgery. The etiologies can be diverse. Extubation of neonates at high risk after cardiac surgery, based on these possible risk factors, requires more diligent approaches.
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Affiliation(s)
- Shinya Miura
- Department of Cardiac Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan.
| | - Nao Hamamoto
- Department of Cardiac Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masaki Osaki
- Department of Cardiac Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Satoshi Nakano
- Department of Cardiac Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Chisato Miyakoshi
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan; School of Mathematics and Statistics, University of Sheffield, Sheffield, United Kingdom
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RECIÉN NACIDO PORTADOR DE CARDIOPATÍA CONGÉNITA COMPLEJA. ANÁLISIS DE RIESGO, TOMA DE DECISIONES Y NUEVAS POSIBILIDADES TERAPÉUTICAS. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Nutritional status and clinical outcome in postterm neonates undergoing surgery for congenital heart disease. Pediatr Crit Care Med 2015; 16:448-52. [PMID: 25828781 DOI: 10.1097/pcc.0000000000000402] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Poor growth is a common complication in infants with congenital heart disease. There has been much focus on low birth weight as having increased risk of adverse outcomes following neonatal heart surgery. In this study, we examined whether preoperative nutritional status, measured by admission weight-for-age z score, was associated with postoperative clinical outcome. DESIGN Retrospective case series. SETTING Pediatric Cardiac ICU at the Royal Brompton Hospital. PATIENTS Neonates undergoing surgery for congenital heart disease. Those undergoing ductus arteriosus ligation alone were excluded. Children with coexisting noncardiac morbidity were excluded. Outcome variables included prevalence of postoperative complications (including sepsis, delayed chest closure, renal impairment, and necrotizing enterocolitis), duration of ventilation, intensive care stay, postoperative mortality, and mortality at 1 year after surgery. INTERVENTIONS None. Analysis of patient data only. MEASUREMENTS AND MAIN RESULTS Two hundred forty-eight neonates fulfilled the entry criteria. Median (interquartile range) age was 7 days (2-15 d), median (interquartile range) weight was 3.3 kg (2.91-3.6 kg), and median weight-for-age z score was -0.77 (-1.44 to 0.01). Twenty-eight children (11%) had a weight-for-age z score of less than -2. There was no evidence that children with lower weight-for-age z score had less severe surgery as measured by the Risk Adjustment for Congenital Heart Surgery 1 score. In multivariable regression analysis, the weight-for-age z at admission had strong correlation with the number of days free of respiratory support (invasive and noninvasive ventilation) at 28 days (p < 0.0001) and with all-cause mortality at 1 year (p = 0.001). CONCLUSIONS Poor nutritional status as measured by weight-for-age z is associated with adverse short- and long-term outcomes in neonates undergoing surgery for congenital heart disease.
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Single Ventricle Palliation in Low Weight Patients Is Associated With Worse Early And Midterm Outcomes. Ann Thorac Surg 2015; 99:668-76. [DOI: 10.1016/j.athoracsur.2014.09.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/08/2014] [Accepted: 09/12/2014] [Indexed: 11/17/2022]
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Alsoufi B, Manlhiot C, Mahle WT, Kogon B, Border WL, Cuadrado A, Vincent R, McCrindle BW, Kanter K. Low-weight infants are at increased mortality risk after palliative or corrective cardiac surgery. J Thorac Cardiovasc Surg 2014; 148:2508-14.e1. [DOI: 10.1016/j.jtcvs.2014.07.047] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/26/2014] [Accepted: 07/16/2014] [Indexed: 11/27/2022]
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Outcomes of cardiac surgery in patients weighing <2.5 kg: affect of patient-dependent and -independent variables. J Thorac Cardiovasc Surg 2014; 148:2499-506.e1. [PMID: 25156464 DOI: 10.1016/j.jtcvs.2014.07.031] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 07/01/2014] [Accepted: 07/05/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A recent Society of Thoracic Surgeons database study showed that low weight (<2.5 kg) at surgery was associated with high operative mortality (16%). We sought to assess the outcomes after cardiac repair in patients weighing <2.5 kg versus 2.5 to 4.5 kg in an institution with a dedicated neonatal cardiac program and to determine the potential role played by prematurity, the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) risk categories, uni/biventricular pathway, and surgical timing. METHODS We analyzed the outcomes (hospital mortality, early reintervention, postoperative length of stay, mortality [at the last follow-up point]) in patients weighing <2.5 kg at surgery (n = 146; group 1) and 2.5 to 4.5 kg (n = 622; group 2), who had undergone open or closed cardiac repairs from January 2006 to December 2012 at our institution. The statistical analysis was stratified by prematurity, STAT risk category, uni/biventricular pathway, and usual versus delayed surgical timing. Univariate versus multivariate risk analysis was performed. The mean follow-up was 21.6 ± 25.6 months. RESULTS Hospital mortality in group 1 was 10.9% (n = 16) versus 4.8% (n = 30) in group 2 (P = .007). The postoperative length of stay and early unplanned reintervention rate were similar between the 2 groups. Late mortality in group 1 was 0.7% (n = 1). In group 1, early outcomes were independent of the STAT risk category, uni/biventricular pathway, or surgical timing compared with group 2. A lower gestational age at birth was an independent risk factor for early mortality in group 1. CONCLUSIONS A dedicated multidisciplinary neonatal cardiac program can yield good outcomes for neonates and infants weighing <2.5 kg independently of the STAT risk category and uni/biventricular pathway. A lower gestational age at birth was an independent risk factor for hospital mortality.
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Costello JM, Pasquali SK, Jacobs JP, He X, Hill KD, Cooper DS, Backer CL, Jacobs ML. Gestational age at birth and outcomes after neonatal cardiac surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Circulation 2014; 129:2511-7. [PMID: 24795388 DOI: 10.1161/circulationaha.113.005864] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Gestational age at birth is a potentially important modifiable risk factor in neonates with congenital heart disease. We evaluated the relationship between gestational age and outcomes in a multicenter cohort of neonates undergoing cardiac surgery, focusing on those born at early term (ie, 37-38 weeks' gestation). METHODS AND RESULTS Neonates in the Society of Thoracic Surgeons Congenital Heart Surgery Database who underwent cardiac surgery between 2010 and 2011 were included. Multivariable logistic regression was used to evaluate the association of gestational age at birth with in-hospital mortality, postoperative length of stay, and complications, adjusting for other important patient characteristics. Of 4784 included neonates (92 hospitals), 48% were born before 39 weeks' gestation, including 31% at 37 to 38 weeks. Compared with a 39.5-week gestational age reference level, birth at 37 weeks' gestational age was associated with higher in-hospital mortality, with an adjusted odds ratio (95% confidence interval) of 1.34 (1.05-1.71; P=0.02). Complication rates were higher and postoperative length of stay was significantly prolonged for those born at 37 and 38 weeks' gestation (adjusted P<0.01 for all). Late-preterm births (34-36 weeks' gestation) also had greater mortality and postoperative length of stay (adjusted P≤0.003 for all). CONCLUSIONS Birth during the early term period of 37 to 38 weeks' gestation is associated with worse outcomes after neonatal cardiac surgery. These data challenge the commonly held perception that delivery at any time during term gestation is equally safe and appropriate and question the related practice of elective delivery of fetuses with complex congenital heart disease at early term.
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Affiliation(s)
- John M Costello
- From the Divisions of Pediatric Cardiology (J.M.C.) and Cardiovascular and Thoracic Surgery (C.L.B.), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pediatrics and Communicable Disease, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, MI (S.K.P.); Department of Surgery, All Children's Hospital and John Hopkins University, Saint Petersburg, FL (J.P.J.); Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (X.H., K.D.H.); The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH (D.S.C.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (M.L.J.).
| | - Sara K Pasquali
- From the Divisions of Pediatric Cardiology (J.M.C.) and Cardiovascular and Thoracic Surgery (C.L.B.), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pediatrics and Communicable Disease, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, MI (S.K.P.); Department of Surgery, All Children's Hospital and John Hopkins University, Saint Petersburg, FL (J.P.J.); Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (X.H., K.D.H.); The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH (D.S.C.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (M.L.J.)
| | - Jeffrey P Jacobs
- From the Divisions of Pediatric Cardiology (J.M.C.) and Cardiovascular and Thoracic Surgery (C.L.B.), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pediatrics and Communicable Disease, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, MI (S.K.P.); Department of Surgery, All Children's Hospital and John Hopkins University, Saint Petersburg, FL (J.P.J.); Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (X.H., K.D.H.); The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH (D.S.C.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (M.L.J.)
| | - Xia He
- From the Divisions of Pediatric Cardiology (J.M.C.) and Cardiovascular and Thoracic Surgery (C.L.B.), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pediatrics and Communicable Disease, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, MI (S.K.P.); Department of Surgery, All Children's Hospital and John Hopkins University, Saint Petersburg, FL (J.P.J.); Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (X.H., K.D.H.); The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH (D.S.C.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (M.L.J.)
| | - Kevin D Hill
- From the Divisions of Pediatric Cardiology (J.M.C.) and Cardiovascular and Thoracic Surgery (C.L.B.), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pediatrics and Communicable Disease, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, MI (S.K.P.); Department of Surgery, All Children's Hospital and John Hopkins University, Saint Petersburg, FL (J.P.J.); Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (X.H., K.D.H.); The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH (D.S.C.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (M.L.J.)
| | - David S Cooper
- From the Divisions of Pediatric Cardiology (J.M.C.) and Cardiovascular and Thoracic Surgery (C.L.B.), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pediatrics and Communicable Disease, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, MI (S.K.P.); Department of Surgery, All Children's Hospital and John Hopkins University, Saint Petersburg, FL (J.P.J.); Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (X.H., K.D.H.); The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH (D.S.C.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (M.L.J.)
| | - Carl L Backer
- From the Divisions of Pediatric Cardiology (J.M.C.) and Cardiovascular and Thoracic Surgery (C.L.B.), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pediatrics and Communicable Disease, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, MI (S.K.P.); Department of Surgery, All Children's Hospital and John Hopkins University, Saint Petersburg, FL (J.P.J.); Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (X.H., K.D.H.); The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH (D.S.C.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (M.L.J.)
| | - Marshall L Jacobs
- From the Divisions of Pediatric Cardiology (J.M.C.) and Cardiovascular and Thoracic Surgery (C.L.B.), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pediatrics and Communicable Disease, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, MI (S.K.P.); Department of Surgery, All Children's Hospital and John Hopkins University, Saint Petersburg, FL (J.P.J.); Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (X.H., K.D.H.); The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH (D.S.C.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (M.L.J.)
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The Importance of Extreme Weight Percentile in Postoperative Morbidity in Children. J Am Coll Surg 2014; 218:988-96. [DOI: 10.1016/j.jamcollsurg.2013.12.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/30/2013] [Accepted: 12/30/2013] [Indexed: 11/18/2022]
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Outcome of low body weight (<2.2 kg) infants undergoing cardiac surgery. J Saudi Heart Assoc 2014; 26:132-7. [PMID: 24954985 DOI: 10.1016/j.jsha.2014.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 02/23/2014] [Accepted: 03/22/2014] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Infants with low body weight (LBW) following cardiac surgery are a major challenge for the post cardiac surgery care unit. It has been observed that post surgery outcome for LBW infants is worse compared to the outcome of normal body weight infants. A study was conducted to compare post operative course and outcome of infants with body weight of 2.2 kg or less against infants with normal body weight who underwent similar cardiac surgeries. METHODS A retrospective review was performed for all infants below 2.2 kg who underwent cardiac operations at King Abdulaziz Cardiac Center from January 2001 to October 2011. Cases with LBW (Group A) were compared with matching group (Group B) of normal body weight infants who had similar cardiac surgeries and matching surgical risk category. The demographic, ICU parameters, complications, and short-term outcome of both groups were analyzed. RESULTS Two groups were formed, with 37 patients in Group A, and 39 patients in Group B. Except for weight (2.13 ± 0.08 kg in Group A vs 3.17 ± 0.2 kg in Group B), there was no statistical difference in demographic data between both groups. Cardiac procedures included coarctation repair, arterial switch, ventricular septal defect (VSD) repair, tetralogy of Fallot repair, systemic to pulmonary shunt and Norwood procedures. Patients in Group A had statistically significant difference from Group B in terms of bypass time (p = 0.01), duration of inotropes (p = 0.01), duration of mechanical ventilation (p = 0.004), number of re-intubations (p = 0.015), PCICU length of stay (p = 0.007), and hospital mortality: 13.5% in Group A vs 0% in Group B (p value 0.02). CONCLUSION Patients with LBW (<2.2 kg) underwent cardiac surgery with overall satisfactory results, but with increased risk of ICU morbidity and mortality.
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Castleberry CD, Gudausky TM, Berger S, Tweddell JS, Pelech AN. Stenting of the right ventricular outflow tract in the high-risk infant with cyanotic teratology of Fallot. Pediatr Cardiol 2014; 35:423-30. [PMID: 24096718 DOI: 10.1007/s00246-013-0796-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 09/14/2013] [Indexed: 12/19/2022]
Abstract
Neonatal tetralogy of Fallot (TOF) repair carries an increased risk of low birthweight or premature infants. Studies are investigating stents in the right ventricular outflow tract (RVOT) as an alternative to aortopulmonary shunts. The authors review their institutional experience with RVOT stenting in the high-risk infant with TOF. Data on sequential patients who received RVOT stents were reviewed, with collection of their surgical, echocardiographic, and catheterization data. Size-matched control subjects were identified and outcomes compared. Six infants went to the catheterization lab for RVOT stenting from 2008 to 2010. Five of these patients had placement of an RVOT stent after balloon dilation. The median saturations were 71% on 48% fraction of inspired oxygen (FiO2), with improvement to 94% (p < 0.001) on 39% FiO2 24 h after stent placement. As shown by echocardiography, the diameter of the median right pulmonary artery (RPA) was 2.6 mm (z-score, -3.3), and the diameter of the left pulmonary artery (LPA) was 2.0 mm (z-score, -4.5). Repeat echocardiography before surgery showed a statistically significant increase in RPA and LPA size as well as a modified McGoon ratio (p < 0.05). Four of the five patients subsequently underwent TOF repair. No stent fractures occurred. One patient had repair 10 days after stent placement secondary to stent malposition and tricuspid valve injury. The authors' experience with stents in the RVOT of TOF patients has yielded good results, with significant improvement in oxygen saturations. Patients had successful elective surgical repair and stent removal without longer cardiopulmonary bypass times or recognizable complications compared with shunted patients.
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Affiliation(s)
- Chesney D Castleberry
- Cincinnati Children's Hospital and Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH, 45229-3026, USA,
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How low can we go? The changing landscape of extracorporeal support in infants*. Pediatr Crit Care Med 2014; 15:88-9. [PMID: 24389713 DOI: 10.1097/01.pcc.0000436199.92465.f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chen JW, Chen YS, Chang CI, Chiu IS, Chou NK, Huang HH, Huang CH, Huang SC. Risk Stratification and Outcome of Cardiac Surgery for Patients With Body Weight <2,500g in an Asian Center. Circ J 2014; 78:393-8. [DOI: 10.1253/circj.cj-13-0970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jeng-Wei Chen
- Departments of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine
| | - Yih-Sharng Chen
- Departments of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine
| | - Chung-I Chang
- Departments of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine
| | - Ing-Sh Chiu
- Departments of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine
| | - Nai-Kuan Chou
- Departments of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine
| | - Hsing-Hao Huang
- Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine
| | - Chi-Hsiang Huang
- Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine
| | - Shu-Chien Huang
- Departments of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine
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Costello JM, McQuillen PS, Claud EC, Steinhorn RH. Prematurity and congenital heart disease. World J Pediatr Congenit Heart Surg 2013; 2:457-67. [PMID: 23803997 DOI: 10.1177/2150135111408445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Significant advances in technology and therapy have led to dramatic improvements in the survival of preterm babies over the last 2 decades. Similarly, improvements in surgical and cardiac intensive care techniques have increased the feasibility of supporting even very small babies to the point of surgical repair, leading some to adopt an approach of early and complete surgical repair in preterm infants, with the aim of minimizing potential preoperative morbidity associated with extended medical management or surgical palliation. (1,2) However, multiple diagnostic and therapeutic challenges complicate the care of premature infants. Major errors in echocardiography are more common in neonates weighing less than 2.5 kg, (3) and the ideal timing and type of surgical intervention in premature infants remains unknown. These problems are compounded by the need for critical care practices that optimize management of immature cardiopulmonary, gastrointestinal, and neurological systems. This review will summarize some of the recent advances in neonatal and perinatal medicine, which have the potential to contribute to improved management of preterm infants with critical cardiac disease.
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Affiliation(s)
- John M Costello
- Department of Pediatrics, Children's Memorial Hospital and Northwestern University, Chicago, IL, USA
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Reddy VM. Low birth weight and very low birth weight neonates with congenital heart disease: timing of surgery, reasons for delaying or not delaying surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2013; 16:13-20. [PMID: 23561813 DOI: 10.1053/j.pcsu.2013.01.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Conventional management of low birth weight and very low birth weight neonates was composed of deferring corrective surgery by aggressive medical management or palliative surgery which does not require cardiopulmonary bypass. However, while waiting for weight gain, these neonates are at risk for various comorbidities. In the current era, this "wait and let the baby grow" approach has not been shown to result in better clinical outcomes. Early primary repair hence has become the standard strategy for congenital heart disease requiring surgery in these neonates. However, there still exist some circumstances, which are considered to be unfavorable for corrective surgery due to medical, physiologic, surgeon's technical and institutional-systemic factors. We reviewed the recent literature and examined the reasons for delaying or not delaying surgery.
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Affiliation(s)
- V Mohan Reddy
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305-5407, USA.
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Congenital heart surgeon's technical proficiency affects neonatal hospital survival. J Thorac Cardiovasc Surg 2012; 144:1119-24. [PMID: 22421402 DOI: 10.1016/j.jtcvs.2012.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 01/23/2012] [Accepted: 02/03/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Risk factors for mortality after neonatal cardiac surgery have been seldom studied. We sought to identify contemporary risk factors for mortality and the impact of surgical technical performance on surgical outcomes after neonatal cardiac surgery. METHODS We conducted a matched case-control study comparing 56 neonates who died after cardiac surgery (2002-2008) with 56 survivors matched by surgical procedure and year of surgery. Surgical efficacy for repair or palliation was graded using a reliable simple surgical technical score. Patient and surgical characteristics were compared for the survivors and nonsurvivors using paired analyses. RESULTS There was no significant difference between patients who died and their matched controls in terms of age, Aristotle score, Risk Adjustment in Congenital Heart Surgery-1 category, and single versus biventricular repair. When compared with survivors, patients who died were more likely to be premature (41% vs 5%, P < .001), to weigh less than 2.5 kg (25% vs 9%, P = .05), and to have inadequate surgical repair or palliation (55% vs 9%, P < .001). Cardiopulmonary bypass time was longer for the patients who died (median, 159 vs 133 minutes, P = .002). Highest postoperative lactate (median, 9.0 vs 6.0, P < .001), use of extracorporeal membrane oxygenation (71% vs 13%, P < .001), and reoperation during the same admission (75% vs 2%, P < .001) were also associated with death. In multivariable analysis, inadequate surgical repair or palliation (odds ratio, 11, P = .02) and need for postoperative extracorporeal membrane oxygenation (odds ratio, 5.1, P = .009) were the only risk factors associated with hospital death. CONCLUSIONS Our study highlights the need for optimal technical performance to minimize neonatal deaths. This has important implications when sustaining or developing a pediatric cardiac program.
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Bang S, Ko HK, Yu JJ, Han MK, Kim YH, Ko JK, Park IS. Right ventricular outflow tract stenting in a low birth weight infant born with tetralogy of fallot and prostaglandin e1 dependency. Korean Circ J 2011; 41:744-6. [PMID: 22259605 PMCID: PMC3257458 DOI: 10.4070/kcj.2011.41.12.744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 02/22/2011] [Indexed: 11/28/2022] Open
Abstract
Surgical skill and strategy for the correction of tetralogy of Fallot (TOF) have improved and resulted in satisfactory outcomes. However, prematurity and low birth weight continue to remain risk factors for poor outcomes. We present a case of a 2,150 g neonate born with TOF, in whom palliation was achieved with right ventricular outflow tract (RVOT) stenting. Seventy-seven days after the procedure, stenosis of RVOT below the stent was identified. At that time his body weight was 4.9 kg and total corrective surgery was deemed feasible. Eight months following surgical repair, the patient remained well without medical intervention. RVOT stenting may be a viable interim procedure while waiting for a low birth weight neonate born with TOF and prostaglandin E1 dependency to reach optimal weight to undergo corrective surgery.
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Affiliation(s)
- Sunhee Bang
- Department of Pediatrics, College of Medicine, University of Ulsan, Seoul, Korea
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Cheng HH, Almodovar MC, Laussen PC, Wypij D, Polito A, Brown DW, Emani SM, Pigula FA, Allan CK, Costello JM. Outcomes and risk factors for mortality in premature neonates with critical congenital heart disease. Pediatr Cardiol 2011; 32:1139-46. [PMID: 21713439 DOI: 10.1007/s00246-011-0036-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 06/15/2011] [Indexed: 11/29/2022]
Abstract
We sought to describe contemporary outcomes and identify risk factors for hospital mortality in premature neonates with critical congenital heart disease who were referred for early intervention. Neonates who were born before 37 weeks' gestation with critical congenital heart disease and admitted to our institution from 2002 to 2008 were included in this retrospective cohort study. Critical congenital heart disease was defined as a defect requiring surgical or transcatheter cardiac intervention or a defect resulting in death within the first 28 days of life. Logistic regression analyses were performed to identify risk factors for mortality before hospital discharge. The study included 180 premature neonates, of whom 37 (21%) died during their initial hospitalization, including 6 (4%) before cardiac intervention and 31 (17%) after cardiac intervention. For the 174 patients undergoing cardiac intervention, independent risk factors for mortality were a 5 min Apgar score ≤ 7, need for preintervention mechanical ventilation, and Risk Adjustment in Congenital Heart Surgery category ≥ 4 or not assignable. Mortality for premature infants with critical congenital heart disease who are referred for early intervention remains high. Patients with lower Apgar scores who receive preintervention mechanical ventilation and undergo more complex procedures are at greatest risk.
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Affiliation(s)
- Henry H Cheng
- Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
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Abstract
Infants of birth weight ≤2500 g are termed low birth weight (LBW). These children often have considerable morbidity from prematurity and intra-uterine growth restriction. Additionally, LBW infants have increased risk for cardiac and noncardiac congenital anomalies and may require surgery. Primary rather than palliative surgical repair of cardiac lesions has been preferred in recent years. However, LBW remains a risk factor for increased mortality and morbidity after open-heart surgery (OHS). There is a paucity of information about the anesthetic challenges presented by LBW infants undergoing OHS. This review summarizes the perioperative issues of relevance to anesthesiologists who manage these high-risk patients. Emphasis is placed on management concerns that are unique to LBW infants. Retrospective data from the authors' institution are provided for those aspects of anesthetic care that lack published studies. Successful outcome often requires substantial hospital resources and collaborative multi-disciplinary effort.
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Affiliation(s)
- Glyn D Williams
- Department of Anesthesiology, Stanford University, Lucile Packard Children’s Hospital, Stanford, CA, USA
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Prise en charge d’une transposition des gros vaisseaux chez un prématuré. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)71058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Romefort B. Place de la chirurgie palliative et du cathétérisme interventionnel chez le prématuré cardiaque. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)71061-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Santoro G, Gaio G, Castaldi B, Palladino MT, Iacono C, Russo MG, Calabrò R. Arterial duct stenting in low-weight newborns with duct-dependent pulmonary circulation. Catheter Cardiovasc Interv 2011; 78:677-85. [PMID: 21538781 DOI: 10.1002/ccd.23076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 02/20/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate feasibility and results of arterial duct (AD) stenting in low-weight newborns with congenital heart disease and duct-dependent pulmonary circulation (CHD-DPC). BACKGROUND AD stenting is nowadays considered a cost-effective alternative to surgical shunt in CHD-DPC. This option might be even more advisable in low-weight neonates (<2.5 kg), who are at higher surgical risk and in whom stent redilation might adapt shunt magnitude to patient's growth. METHODS Between April 2003 and September 2010, 76 neonates with CHD-DPC underwent AD stenting at our institution, as lower-risk palliation with respect to surgical shunt. Procedural and follow-up data of the 15 low-weight newborns (2.0 ± 0.3 kg, median 2.2) (group I) were compared with the remaining normal-weight newborns (3.5 ± 0.7 kg, median 3.2) (group II). RESULTS Feasibility, complication rate, and need for surgical shunt did not significantly differ between groups. Global X-ray exposure was significantly higher in the low-weight group (82 ± 108 vs. 30 ± 33 Gray/cm(2) , P < 0.002), which maybe due to a longer angiographic presenting work-up. In-hospital mortality rate was 14.3% (vs. 1.9% in the group II, P = NS), although none of the fatalities was procedure-related. During follow-up, five patients (35.7% vs. 15.7% in the group II, P = NS) underwent stent redilation before surgical repair. At control angiography, the Nakata and McGoon indexes had significantly increased (P < 0.05 for both comparisons), without any significant difference with the group II (162 ± 52% vs. 144 ± 158% and 40 ± 17% vs. 42 ± 38%, P = NS). CONCLUSIONS AD stenting is also feasible and effective in low-weight newborns with CHD-DPC, supporting the spontaneous improvement process or promoting a significant pulmonary artery growth.
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Affiliation(s)
- Giuseppe Santoro
- Cardiology, AO Monaldi, 2nd University of Naples, Naples, Italy.
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Yamasaki Y, Shime N, Miyazaki T, Yamagishi M, Hashimoto S, Tanaka Y. Fast-track postoperative care for neonatal cardiac surgery: a single-institute experience. J Anesth 2011; 25:321-9. [DOI: 10.1007/s00540-011-1130-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 03/07/2011] [Indexed: 10/18/2022]
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Primary repair of aortopulmonary window with an interrupted aortic arch in a very low-birth-weight premature neonate. Pediatr Cardiol 2011; 32:221-3. [PMID: 21082173 DOI: 10.1007/s00246-010-9844-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 11/01/2010] [Indexed: 10/18/2022]
Abstract
The aortopulmonary window concomitant with an interrupted aortic arch is a rare occurrence. We successfully performed an emergency one-stage surgical repair of the aortopulmonary window (type 1) concomitant with an interrupted aortic arch (type A) in the case of a very low-birth-weight (1230-g) premature 2-day-old neonate. We describe the diagnosis, surgery, and postoperative course of this rare occurrence.
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Jennings E, Cuadrado A, Maher KO, Kogon B, Kirshbom PM, Simsic JM. Short-term outcomes in premature neonates adhering to the philosophy of supportive care allowing for weight gain and organ maturation prior to cardiac surgery. J Intensive Care Med 2011; 27:32-6. [PMID: 21257629 DOI: 10.1177/0885066610393662] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prematurity is a recognized risk factor for morbidity and mortality following cardiac surgery. The purpose of this study was to examine short-term outcomes following cardiac surgery in premature neonates adhering to our institutional philosophy of supportive care allowing for weight gain and organ maturation. METHODS Retrospective review of all neonates undergoing cardiac surgery from January 2002 to May 2008. A total of 810 neonates (<30 days of age) were identified. Prematurity defined as less than 36 weeks of gestation. Neonates undergoing ductus arteriosus ligation alone were excluded. In all, 63 neonates comprised the premature group. Term group comprised 244 randomly selected term neonates in a 1:4 ratio. Outcome variables were compared between the 2 groups. RESULTS Median gestation 34 weeks, range 24 to 35 weeks. Defects: 2 ventricle, normal arch (41% premature vs 44% term; P = .7), 2 ventricle, abnormal arch (24% vs 22%; P = .8), single ventricle, normal arch (21% vs 15%; P = .2), single ventricle, abnormal arch (14% vs 19%; P = .4). Premature neonates were older and smaller at surgery. Cardiopulmonary bypass procedures were performed less frequently in premature neonates (49% vs 69%; P = .004). Length of mechanical ventilation at our institution (6 days [0.5-54) vs 4 days [0.5-49); P = .06); postoperative hospital stay at our institution (17 days [1-161) vs 15 days [0-153); P = .06); and mortality (16% vs 11%; P = .2) was not different between the 2 groups. CONCLUSION Early outcome seems independent of weight, prematurity, cardiopulmonary bypass, and type of first intervention. Importantly, there was no statistical difference in mortality between the 2 groups, regardless of how they were treated. Further long-term follow-up is needed in this patient population.
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Alkan-Bozkaya T, Türkoğlu H, Akçevin A, Paker T, Özkan-Çerçi H, Dindar A, Ersoy C, Bayer V, Aşkın D, Ündar A. Cardiac Surgery of Premature and Low Birthweight Newborns: Is a Change of Fate Possible? Artif Organs 2010; 34:891-7. [DOI: 10.1111/j.1525-1594.2010.01160.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shepard CW, Kochilas LK, Rosengart RM, Brearley AM, Bryant R, Moller JH, St. Louis JD. Repair of major congenital cardiac defects in low-birth-weight infants: Is delay warranted? J Thorac Cardiovasc Surg 2010; 140:1104-9. [DOI: 10.1016/j.jtcvs.2010.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/12/2010] [Accepted: 08/09/2010] [Indexed: 11/26/2022]
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