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Published on: May 24, 2016
Early survival of infants weighing 2.5 kilograms or less undergoing first-stage reconstruction for hypoplastic left
S Weinstein1, J W Gaynor, N D Bridges
1Division of Pediatric Cardiothoracic Surgery, Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA.
Insights
Low body weight in infants with hypoplastic left heart syndrome (HLHS) or similar conditions does not preclude staged reconstructive surgery. This study found no significant correlation between low weight and mortality, suggesting weight alone is not a contraindication.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Neonatal Intensive Care
Background:
- Staged palliation for hypoplastic left heart syndrome (HLHS) has improved survival rates.
- Certain risk factors are associated with decreased survival in HLHS patients.
- The role of low body weight as a contraindication for surgery requires further investigation.
Purpose of the Study:
- To evaluate the impact of low body weight on survival rates in neonates undergoing the first stage of reconstructive surgery for congenital heart defects.
- To determine if low weight alone is a contraindication for staged palliative surgery in HLHS and similar conditions.
Main Methods:
- Retrospective review of medical records for 67 patients weighing <=2.5 kg who underwent initial reconstructive surgery between 1990 and 1997.
- Analysis of patient demographics, diagnoses (including HLHS, complex double-outlet right ventricle, unbalanced AV canal, tricuspid atresia with transposition of the great vessels), age at surgery, weight, and early mortality.
- Statistical analysis to identify correlations between patient, procedural, or time-related variables and mortality.
Main Results:
- Early mortality was 51% (34 of 67 patients).
- No patient, procedural, or time-related variables significantly correlated with increased mortality.
- A trend toward increased mortality was observed with longer cardiopulmonary bypass times (P=0.076) and decreased preoperative ventricular performance (P=0.139).
Conclusions:
- Low body weight alone should not be considered a contraindication for staged reconstructive surgery in patients with HLHS or similar complex congenital heart conditions.
- These findings support the consideration of surgical intervention for low-weight infants based on the overall clinical picture rather than solely on weight.
- Further research may explore specific thresholds or combined risk factors influencing outcomes in this population.
Background:
Results of staged palliation for hypoplastic left heart syndrome (HLHS) have improved in recent years; however, certain risk factors have been associated with decreased survival rates.
Methods And Results:
We retrospectively reviewed the medical records of 67 patients weighing
Conclusions:
These findings suggest that low weight alone in a patient with HLHS or an anatomic variant should not be considered a contraindication to staged reconstructive surgery.
