Outcomes of surgical management in low birth weight neonates and premature infants with congenital heart defect / 中华胸心血管外科杂志

ABSTRACT

Objective To evaluate the outcomes of cardiac surgery in neonates weighing less than 2500g and premature infants. Methods From January 2000 through March 2005, 36 consecutive critically symptomatic neonates (26 males, 10 females) weighing less than 2500g underwent cardiac surgery at our center. Median gestational age was 34 weeks with 24 (70.6%) premature (≤37 weeks). Median age at operation was 15.5 days (from 4 days to 68 days). Median weight was 2120g (from 700g to 2500g). Indications for surgery were persistent ductus arteriosus (PDA, n=15), coarctation of the aorta (CoA, n=3), transposition of great arteries with severely hypoplastic aortic arch (TGA/HAA, n=1), ventricular septal defect (VSD, n=10), pulmonary atresia with intact ventricular septum (PA/IVS, n=5), total abnormal pulmonary venous return (TAPVR, n=2). The heart functions of all patients were assessed in NYHA class IV and 7 patients (19.4%) were intubated pre-operatively. 18 cases (50%) needed extracorporeal circulation and deep hypothermia with circulatory arrest was used in 6 patients. Results The overall mortality was 11.1%. The causes of death were left heart failure in 1 patient and multiorgan failure in 2 and hypoxmia in 1. Mean extracorporeal circulation time was 92 min (from 72 min to 198 min). Mean aortic cross-clamping time was 76 min (from 46 min to 158 min). Mean deep hypothermia with circulatory arrest Peritoneum dialysis was carried out in 5 cases. Mean follow-up period was 22. 3 months (from 2 months to 46 months). 2 patients underwent reoperation and catheter intervention respectively. The heart functions of 26 patients (81.4%) were in NYHA class I at the latest clinical examination. Conclusion This study suggests that complete repair of simple and complex congenital heart diseases can be performed effectively in low birth weight neonates with acceptable mortality and morbidity. Low weight alone should not be considered as a contraindication to surgery in these patients. It is recommended that such neonates undergo early surgical correction rather than prolonged conservative palliation.