Related Experiment Videos
Cardiac surgery in infants with very low birth weight
1Division of Cardiothoracic Surgery, University of California, San Francisco, USA.
Insights
Early surgical repair of congenital heart defects in very low birth weight infants (<1,500 g) is safe and effective. Delaying surgery increases morbidity and offers no benefit for these vulnerable patients.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Neonatal Intensive Care
Background:
- Congenital heart defects (CHDs) in low birth weight infants are often managed with delayed definitive repair.
- This approach is associated with high morbidity.
- Outcomes for very low birth weight infants (<1,500 g) undergoing early repair are not well-documented.
Purpose of the Study:
- To evaluate the safety and efficacy of complete surgical repair of CHDs in infants weighing 1,500 g or less.
- To compare outcomes of early repair versus delayed management in this high-risk population.
Main Methods:
- Retrospective analysis of 20 infants weighing ≤1,500 g who underwent complete CHD repair (excluding isolated patent ductus arteriosus) since 1990.
- Inclusion of various complex CHDs: aortic coarctation, VSD, TOF, TGA, truncus arteriosus, TAPVR, DORV, PA-IVS.
- Modified neonatal cardiopulmonary bypass techniques were employed.
Main Results:
- 2 early deaths (10%) occurred due to foot gangrene and pulmonary complications; no intracranial hemorrhage was observed.
- At a median follow-up of 40 months, 1 late death and 4 reinterventions (surgical/catheter) were recorded.
- No neurological sequelae attributable to surgery were found; postoperative growth approximated controls.
Conclusions:
- Delaying repair of CHDs in low and very low birth weight infants offers no benefit and increases preoperative morbidity.
- Complete repair of simple and complex CHDs is feasible and yields good early and medium-term results in this population.
- Early surgical correction is recommended for symptomatic infants with CHDs, especially those weighing <1,500 g.
Abstract:
Congenital heart defects in low birth weight infants are typically managed with supportive therapy or palliative surgery, and definitive repair is delayed. However, the morbidity of such an approach has been shown to be high. Recent reports emphasize early surgical repair with good results in low birth weight and premature babies. However, there are no data on the outcomes in infants with very low birth weight (<1,500 g). Since 1990, the authors performed complete repair of congenital heart defects (other than isolated patent ductus arteriosus) in 20 infants weighing 1,500 g or less. Defects included aortic coarctation (n = 6), ventricular septal defect (n = 5), tetralogy of Fallot (n = 2), transposition of great arteries (n = 2), truncus arteriosus (n = 2), total anomalous pulmonary venous return (n = 1), double outlet right ventricle (n = 1), and pulmonary atresia with intact ventricular septum (n = 1). Preoperative morbidity was more common in patients who were referred late for corrective surgery. Modification of techniques of neonatal cardiopulmonary bypass were used. There were 2 early deaths (10%) caused by foot gangrene (n = 1), and pulmonary complications (n = 1). No patient had evidence of postbypass intracranial hemorrhage. At a median follow-up of 40 months, there was 1 late death, and 4 patients underwent a total of 5 surgical and catheter reinterventions. There was no evidence of neurological sequelae attributable to surgery. In most cases, delaying repair of congenital heart defects in low and very low birth weight infants does not confer any benefit and is associated with a higher incidence of preoperative morbidity. Complete repair of both simple and complex congenital heart lesions can be performed successfully in such patients with good early and medium-term results. Postoperative growth after repair approximates the normal growth curve for low birth weight infants without congenital heart disease. It is recommended that with few exceptions, such infants, especially when symptomatic, undergo early surgical correction rather than prolonged medical management or other forms of palliation.