The Outcome of Cardiac Surgery in Low Birth Weight Infants

Sung, Si Chan; Kim, Si Ho; Lee, Young Seok

Abstract

BACKGROUND: It is known that low birth weight is a risk factor for poor outcome in cardiac surgery for many cardiac defects.We reviewed our recent surgical experiences on congenital heart defect (other than patent ductus arteriosus)in low birth wei ght babi es.Material and METHOD: From September 1994 to February 2001,31 consecutive infants weighing 2500 g or less underwent cardiac surgery with (OHS group n=12)or without cardiopulmonary bypass (CHS group n=19).A retrospective study was carried out to evaluate short-and intermediate-term outcome.Mean gestational age and age at operation were 36.9 weeks(range,32.3-42weeks)and 32.1days (range,0-87days)respectively.Mean body weight at birth and operation were 1972g (range,1100-2500g)and 2105g (range,1450-2500 g)respectively.There was no difference between the two groups in age and body weight.Defects included ventricular septal defect (VSD)(n=3),VSD with arch anomaly (n=2),total anomalous pulmonary venous return (n=2),transposition of the great arteries (TGA)(n=2),truncus arteriosus (n=2),and univentricular heart with cor triatriatum (n=1)in OHS group,and coarctation of aorta (n=7),tetralogy of Fallot (TOF)(n=3),TOF with pulmonary atresia (n=3), multiple muscular VSDs (n=1),double outlet right ventricle (n=1),pulmonary atresia with intact ventricular septum (n=2),tricuspid atresia (n=1),and TGA with multiple VSD (n=1)in CHS group.13 patients (41.9%)were intubated pre-operatively. RESULT: There were 4 early deaths (<30 days);1 (8.3%)in OHS group and 3 (15.8%)in non-OHS group.All these early deaths were related to the pulmonary artery banding(PAB).There was no operative mortality in infants undergoing complete repair and palliative operations other than PAB.Delayed sternal closure was required in 3 patients.Prolonged postoperative mechanical ventilation (>7days)was required in 7 patients (58.3%)in OHS and 7 (38.8%)in CHS group.Late mortality occurred in 3 patients,two of which were non-cardiac.A patient in OHS group was documented to have neurologic sequelae.All the survivors except two are in NYHA class I.
CONCLUSION
Complete repair and palliative operations other than PAB can be performed in low birth weight infants with low operative mortality and an acceptable intermediate-term result.However,about a half of the patients required long-term postoperative mechanical ventilation.