Low Weight in Congenital Heart Surgery: Is it the Right Way?

Abstract

Objective: There is ample evidence that premature and low birth weight children have a poor outcome after congenital heart surgery. The aim of the present study was to characterize the perioperative factors which significantly influence the outcome of these babies following cardiac surgery, and to clarify whether the RACHS-1 and the Aristotle score are compatible for this complex kind of heart surgery. Methods: During the past 10 years, 108 children with a body weight of less than 3000 g were operated, including 43 premature babies. Mean weight at operation was 2.5 ± 0.5 kg, mean age was 36.8 ± 55 days. Fifty percent of the treatments were categorized into risk groups 4 and 6 and 54 % belonged to the complexity levels 3 and 4. Eighty-one operations (75 %) were performed using extracorporeal circulation. Results: The 30 day mortality rate was 18 %, and the overall mortality rate was 30 %. The correlation between mortality rates and risk groups was significant (p < 0.001). Other significant factors were preoperative acidosis (p = 0.026), preoperative catecholamine support (p < 0.001), prolonged ICU stay (> 7 days) after operation (p < 0.001), and postoperative infection (p = 0.019). In addition, X-clamp time (p = 0.029) and palliative procedures (p < 0.001) were significant factors for poor outcome. Conclusion: The results demonstrate that the mortality for correction of congenital heart defects in children weighing less than 3000 g depends on several factors. The risk groups of the RACHS-1 study and the complexity levels of the Aristotle score are useful tools to assess preoperative risk.

Congenital heart surgery - low weight - RACHS-1 - Aristotle score - outcome

References

• 1 Beyens T, Biarent D, Bouton J M, Demanet H, Viart P, Dessy H, Deville A, Lamote J, Deuvaert F E. Cardiac surgery with extracorporeal circulation in 23 infants weighing 2500 g or less: short and intermediate term outcome.  Eur J Cardiothorac Surg. 1998;  14 165-172
• 2 Boethig D, Jenkins K J, Hecker H, Thies W R, Breymann T. The RACHS-1 risk categories reflect mortality and length of hospital stay in a large German pediatric cardiac surgery population.  Eur J Cardiothorac Surg,. 2004;  26 12-17
• 3 Borowski A, Schickendantz S, Mennicken U, Korb H. Open heart interventions in premature low- and very-low birth-weight neonates: risk profile and ethical considerations.  Thorac Cardiovasc Surg. 1997;  45 238-241
• 4 Bovè T, Francois K, De Groote K, Suys B, De Wolf D, Verhaaren H, Matthys D, Moerman A, Poelaert J, Vanhaesebroeck P, Van Nooten G. Outcome analysis of major cardiac operations in low weight neonates.  Ann Thorac Surg. 2004;  78 181-187
• 5 Carrel T. [Surgery in congenital heart defects: current developments and a few case examples].  Schweiz Rundsch Med Prax. 1997;  86 704-709
• 6 Castaneda A R, Mayer Jr J E, Jonas R A, Lock J E, Wessel D L, Hickey P R. The neonate with critical congenital heart disease: repair - a surgical challenge.  J Thorac Cardiovasc Surg. 1989;  98 (5 Pt 2) 869-875
• 7 Chang A C, Hanley F L, Lock J E, Castaneda A R, Wessel D L. Management and outcome of low birth weight neonates with congenital heart disease.  J Pediatr. 1994;  124 461-466
• 8 Chow G, Koirala B, Armstrong D, McCrindle B, Bohn D, Edgell D, Coles J, de Veber G. Predictors of mortality and neurological morbidity in children undergoing extracorporeal life support for cardiac disease.  Eur J Cardiothorac Surg. 2004;  26 38-43
• 9 Fyler C. Report of the New England Regional Infant Cardiac Program.  Pediatrics. 1980;  65 (Suppl) 375-461
• 10 Jenkins K J. Risk adjustment for congenital heart surgery: the RACHS-1 method.  Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2004;  7 180-184
• 11 Jenkins K J, Gauvreau K. Center-specific differences in mortality: preliminary analyses using the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method.  J Thorac Cardiovasc Surg. 2002;  124 97-104
• 12 Jenkins K J, Gauvreau K, Newburger J W, Spray T L, Moller J H, Iezzoni L I. Consensus-based method for risk adjustment for surgery for congenital heart disease.  J Thorac Cardiovasc Surg. 2002;  123 110-118
• 13 Kang N, Cole T, Tsang V, Elliott M, de Leval M. Risk stratification in paediatric open-heart surgery.  Eur J Cardiothorac Surg. 2004;  26 3-11
• 14 Kawata H, Kishimoto H, Miura T, Nakajima T, Kitajima H. Surgical management of congenital cardiac defects in neonates and young infants born with extremely low weight.  Cardiol Young. 2003;  13 328-332
• 15 Kecskes Z, Cartwright D W. Poor outcome of very low birthweight babies with serious congenital heart disease.  Arch Dis Child Fetal Neonatal Ed. 2002;  87 F31-33
• 16 Kirklin J K, Blackstone E H, Kirklin J W, McKay R, Pacifico A D, Bargeron Jr L M. Intracardiac surgery in infants under age 3 months: predictors of postoperative in-hospital cardiac death.  Am J Cardiol. 1981;  48 507-512
• 17 Kopf G S, Mello D M. Surgery for congenital heart disease in low-birth weight neonates: a comprehensive statewide Connecticut program to improve outcomes.  Conn Med. 2003;  67 327-332
• 18 Kramer H H, Trampisch H J, Rammos S, Giese A. Birth weight of children with congenital heart disease.  Eur J Pediatr. 1990;  149 752-757
• 19 Kuhlthau K, Ferris T G, Iezzoni L I. Risk adjustment for pediatric quality indicators.  Pediatrics. 2004;  113 (1 Pt 2) 210-216
• 20 Lacour-Gayet F. Risk stratification theme for congenital heart surgery.  Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2002;  5 148-152
• 21 Lacour-Gayet F. Quality evaluation in congenital heart surgery.  Eur J Cardiothorac Surg. 2004;  26 1-2
• 22 Lacour-Gayet F, Clarke D, Jacobs J, Comas J, Daebritz S, Daenen W, Gaynor W, Hamilton L, Jacobs M, Maruszsewski B, Pozzi M, Spray T, Stellin G, Tchervenkov C, Mavroudis C. The Aristotle score: a complexity-adjusted method to evaluate surgical results.  Eur J Cardiothorac Surg. 2004;  25 911-924
• 23 Lacour-Gayet F, Clarke D, Jacobs J, Gaynor W, Hamilton L, Jacobs M, Maruszewski B, Pozzi M, Spray T, Tchervenkov C, Mavroudis C. The Aristotle score for congenital heart surgery.  Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2004;  7 185-191
• 24 Mayer Jr J E. Pediatric cardiac surgery.  Curr Opin Cardiol. 1991;  6 119-138
• 25 McElhinney D B, Wernovsky G. Outcomes of neonates with congenital heart disease.  Curr Opin Pediatr. 2001;  13 104-110
• 26 Numa A, Butt W, Mee R B. Outcome of infants with birthweight 2000 g or less who undergo major cardiac surgery.  J Paediatr Child Health. 1992;  28 318-320
• 27 Oppido G, Napoleone C P, Formigari R, Gabbieri D, Pacini D, Frascaroli G, Gargiulo G. Outcome of cardiac surgery in low birth weight and premature infants.  Eur J Cardiothorac Surg. 2004;  26 44-53
• 28 Pawade A, Waterson K, Laussen P, Karl T R, Mee R B. Cardiopulmonary bypass in neonates weighing less than 2.5 kg: analysis of the risk factors for early and late mortality.  J Card Surg. 1993;  8 1-8
• 29 Reddy V M. Cardiac surgery for premature and low birth weight neonates.  Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2001;  4 271-276
• 30 Reddy V M, Hanley F L. Cardiac surgery in infants with very low birth weight.  Semin Pediatr Surg. 2000;  9 91-95
• 31 Reddy V M, McElhinney D B, Sagrado T, Parry A J, Teitel D F, Hanley F L. Results of 102 cases of complete repair of congenital heart defects in patients weighing 700 to 2500 grams.  J Thorac Cardiovasc Surg. 1999;  117 324-331
• 32 Rossi A F, Seiden H S, Sadeghi A M, Nguyen K H, Quintana C S, Gross R P, Griepp R B. The outcome of cardiac operations in infants weighing two kilograms or less.  J Thorac Cardiovasc Surg. 1998;  116 28-35
• 33 Wernovsky G, Rubenstein S D, Spray T L. Cardiac surgery in the low-birth weight neonate. New approaches.  Clin Perinatol. 2001;  28 249-264