Cardiology in the Young

Original Articles

Morbidity and mortality after surgery for congenital cardiac disease in the infant born with low weight

Anne M. Ades MDa1 c1, Troy E. Dominguez MDa2, Susan C. Nicolson MDa2, James W. Gaynor MDa3, Thomas L. Spray MDa3, Gil Wernovsky MDa2a4 and Sarah Tabbutt MD, PhDa2a4

a1 Department of Pediatrics, Division of Neonatology, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

a2 Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

a3 Department of Surgery, Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

a4 Department of Pediatrics, Division of Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Abstract

Objective Low weight at birth is a risk factor for increased mortality in infants undergoing surgery for congenitally malformed hearts. There has been a trend towards performing surgery in patients early, and for amenable lesions, in a single stage rather than following initial palliative procedures. Our goal was to report on the current incidences of morbidities and mortality in infants born with low weight and undergoing surgery for congenital cardiac disease.

Methods We made a retrospective review of the data from patients meeting our criterions for entry from July, 2000, through July, 2004. The criterions for inclusion were weight at birth less than or equal to 2500 grams, and congenital cardiac malformations requiring surgery during the initial hospitalization. A criterion for exclusion was isolated persistent patency of the arterial duct. We assessed preoperative, intraoperative, and postoperative variables.

Results We found a total of 105 patients meeting the criterions for inclusion. The median weight at birth was 2130 grams, and median gestational age was 36 weeks. The most common morbidity identified was infections of the blood stream. Infections, and chronic lung disease, were associated with increased length of stay. Survival overall was 76%. Patients with hypoplastic left heart syndrome, or a variant thereof, had the lowest survival, of 62%. The needs for cardiopulmonary resuscitation, or extracorporeal membrane oxygenation, post-operatively were the only factors identified as independent risk factors for mortality.

Conclusion Patients undergoing surgery during infancy for congenital cardiac disease who are born with low weight have a higher mortality and morbidity than those born with normal weight.

(Received March 26 2009)

(Accepted June 14 2009)

(Online publication December 18 2009)

Correspondence:

c1 Correspondence to: Anne M. Ades MD, Division of Neonatology, 2nd Floor, Main Building, The Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104. Tel: 215-590-1653; Fax: 215-590-3081; E-mail: ades@email.chop.edu