Cardiac surgical strategy for extremely low-birthweight infants with pulmonary overcirculation

This study aimed to review the clinical outcomes of staged cardiac surgery in extremely low-birthweight infants with congenital heart disease and pulmonary overcirculation.

Six extremely low-birthweight infants with congenital heart disease and pulmonary overcirculation underwent staged cardiac surgery between 2005 and 2017. The median birthweight was 895 g (range 620-990 g), and the median gestational age was 28 weeks (range 23-31 weeks). Clinical outcomes were evaluated, and we focused on pulmonary haemodynamics.

Pulmonary artery banding or bilateral pulmonary artery banding was performed as the initial palliation at a median age of 23 days with a median body weight of 880 g. Corrective surgery was performed at a median age of 187 days with a median body weight of 3.9 kg. All of the patients successfully underwent corrective surgery and survived to date. Pulmonary hypertension regressed after corrective surgery in all of the patients, except for 1 patient with severe bronchopulmonary dysplasia.

Acceptable outcomes can be obtained by staged cardiac surgery in extremely low-birthweight infants with congenital heart disease and pulmonary overcirculation. While early pulmonary artery banding can lead to regression of pulmonary hypertension after corrective surgery, close follow-up is required.