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| Repair of Major Cardaic Defects in Low Birth Weight Infants: Is Delayed Surgical Intervention Warrented? |
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Charles Shepard2, James H. Moller2, Roosevelt Bryant1, Ronald M. Rosengart2, James D. St.Louis1; 1Dept. of Surgery, University of Minnesota, Minneapolis, MN; 2Dept. of Pediatrics, University of Minnesota, Minneapolis, MN Objective: Few studies have accurately described survival in neonates weighing less than 1.5 kg at the time of surgical correction for a major congenital cardiac defect. The goal of this study was to confirm the hypothesis that early intervention in this population has comparable survival to individual in which repair is delayed. Methods: A mutli-institutional retrospective review of patients that underwent correction of a major cardiac surgical anomaly with cohorts divided into individuals either weighing less than 1.5 kg or between 1.5 to 2.5 kg. Operative ligation of a PDA or other minor surgical procedures were excluded from this analysis. Survival was defined as either discharge from the hospital or alive at the next major cardiac operation. Results: Four hundred forty one patients who underwent operative repair of a major cardiac anomaly were included in this review. Cohort 1 consisted of 172 patients weighing less than 1.5 kg, while cohort 2 included 269 patients weighing between 1.5 and 2.5 kg. The number of patients categorized to RACHS-1 scores for cohorts 1 and 2 were: 3 and 7 (1); 79 and 114 (2); 47 and 84 (3); 11 and 35 (4); 11 and 9 (6) respectively. In patients weighing less than 1.2 kg, overall survival was 65%. In those between 1.2 - 1.5 kg, survival was 79 %. In infants weighing less than 1.5 kg at birth, but were between 1.5 and 2.5 kg at operation, survival was 77%. Operative procedures not requiring cardiopulmonary bypass, survival was 79% for less than 1.5 kg and 87% between 1.5-2.5 kg. For patient requiring cardiopulmonary bypass, survival was 62% in the group less than 1.5 kg and 59% in the 1.5 to 2.5 kg group. Weight was not an independent risk factor for mortality. Operations were performed on a greater number of low weight infants each year over the period of the study. No notable improvement in outcome over time was found for those individuals weighing more than 1.2 kg. There was a trend toward improved outcome over time for those weighing less than 1.2 kg, but not statistically significant. Conclusion: Survival in infants weighing less than 1.5 kg is comparable to infants that undergo a major cardiac procedure at a greater weight. These data suggest that operative delay secondary to size is not warranted. Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
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Copyright © 2012 American Association for Thoracic Surgery
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.