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Low-weight infants are at increased mortality risk after palliative or corrective cardiac surgery
Bahaaldin Alsoufi1, Cedric Manlhiot2, William T Mahle3
1Division of Cardiothoracic Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga.
Insights
Low weight in infants undergoing cardiac surgery remains a significant risk factor for mortality and longer hospital stays. These risks persist beyond the initial recovery period, necessitating targeted management strategies.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Neonatal Intensive Care
Background:
- Low infant weight is a known risk factor for mortality following congenital cardiac surgery.
- Advances in neonatal and infant post-surgical care warrant re-examination of low weight's impact.
Purpose of the Study:
- To evaluate the effect of low weight on early and late outcomes in infants undergoing cardiac surgery in the current era.
- To identify specific risks associated with low weight (≤ 2.5 kg) in this patient population.
Main Methods:
- Analysis of 2051 infants (≤ 90 days old) undergoing cardiac surgery between 2002-2012.
- Use of regression models to assess the impact of low weight (≤ 2.5 kg) on mortality, reoperation, ECMO, and resource utilization.
- Hazard analysis for late survival outcomes.
Main Results:
- Infants weighing ≤ 2.5 kg had higher rates of prematurity and abnormalities, but similar single-ventricle pathology incidence.
- Low weight was associated with increased hospital mortality (OR, 2.15) and longer mechanical ventilation, ICU, and hospital stays.
- Low weight significantly diminished late survival (HR, 1.89) for up to one year post-surgery.
Conclusions:
- Low weight remains a significant predictor of increased early mortality and resource utilization in congenital cardiac surgery.
- The increased risk of death for low-weight infants extends beyond the perioperative period.
- Improved outcomes require enhanced perioperative care, outpatient surveillance, and management strategies for this high-risk group.
Background:
Low weight is an established risk factor for mortality after congenital cardiac surgery. Given the advances in the care of neonates and infants after surgery, we sought to examine the effect of low weight on outcomes in the current era.
Methods:
From 2002 to 2012, 2051 infants aged 90 days or less underwent cardiac surgery including 534 (26.0%) with single-ventricle pathology. Regression models examined the effect of low weight (≤ 2.5 kg; n = 274, 13.4%) on early and late outcomes.
Results:
Overall, the incidence of prematurity, associated chromosomal/extracardiac abnormalities was higher in infants who weighed 2.5 kg or less than in those who weighed more than 2.5 kg; the incidence of single-ventricle pathology was comparable between the 2 groups. In addition, infants who weighed 2.5 kg or less underwent more palliation and had a higher proportion of STAT (Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery) risk category 4 and 5 procedures. Adjusted regression models showed that low weight (≤ 2.5 kg) did not increase unplanned reoperation (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.48-1.67; P = .73) or extracorporeal membrane oxygenation requirement (OR, 1.23; 95% CI, 0.68-2.22; P = .49), however it was associated with significant increase in hospital mortality (OR, 2.15; 95% CI, 1.33-3.50; P = .002). In addition, there was a significant association between low weight and increased duration of postoperative mechanical ventilation and intensive care unit and hospital stays. Adjusted hazard analysis showed that weight equal to or less than 2.5 kg was associated with diminished late survival (hazard ratio, 1.89; 95% CI, 1.39-2.55; P < .001) and that was evident in all patients subgroups (P < .001 for all).
Conclusions:
In a large single-center series, low weight continues to be associated with increased early mortality risk and resource utilization after palliative and corrective cardiac surgery. The hazard of death in low-weight patients continues beyond the perioperative period for at least 1 year before normalizing. Strategies to improve outcomes for this high-risk population must address perioperative care, outpatient surveillance, and management.
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