Complex neonatal congenital heart surgery in Nevada

Area of Science:

• Pediatric Cardiac Surgery
• Neonatal Intensive Care
• Congenital Heart Disease

Background:

• Neonatal cardiovascular surgery is complex and carries significant risk.
• The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) categorizes surgical risk, with categories 4 and 5 representing the highest risk.

Purpose of the Study:

• To evaluate surgical mortality rates in neonates undergoing STAT category 4 or 5 cardiovascular surgery.
• To determine if patient weight, presence of syndromes, or noncardiac malformations influence mortality in this high-risk group.

Main Methods:

• A retrospective review of patients undergoing STAT category 4 or 5 neonatal index cardiovascular surgical procedures between July 2015 and July 2021.
• Patients were stratified by weight at the time of surgery: ≤2.5 kg and >2.5 kg.
• Mortality rates were compared between weight groups and analyzed in relation to syndromes and noncardiac malformations.

Main Results:

• A total of 239 patients were identified and divided into two weight groups: ≤2.5 kg (n=42) and >2.5 kg (n=197).
• The incidence of syndromes or noncardiac malformations was significantly higher in the ≤2.5 kg group (42.9%) compared to the >2.5 kg group (17.3%), p=0.0093.
• Thirty-day discharge mortality was similar between the groups: 7.1% for those ≤2.5 kg versus 5.1% for those >2.5 kg, p=0.83.

Conclusions:

• Patient weight at the time of complex neonatal cardiovascular surgery (STAT category 4 or 5) did not significantly affect mortality.
• The presence of syndromes or associated noncardiac malformations did not impact mortality in this patient cohort.
• These findings suggest that risk stratification beyond weight and comorbidities may be necessary for predicting outcomes in high-risk neonatal cardiac surgery.