Azakie Anthony, Johnson Natalie C, Anagnostopoulos Petros V, Egrie Glenn D, Lavrsen Michael J, Sapru Anil
UCSF Benioff Children's Hospital, San Francisco, CA, USA.
Interact Cardiovasc Thorac Surg. 2011 Mar;12(3):409-13, discussion 414. doi: 10.1510/icvts.2010.253823. Epub 2010 Nov 24.
Low birth weight (LBW) is a risk factor for mortality in neonatal and infant heart surgery. The purpose of this study was to determine the contemporary outcomes and risk factors of cardiac surgery in low weight babies. The records of 75 consecutive infants weighing <2.5 kg having heart surgery were reviewed. The median weight was 2100 g (range 800-2500 g) and median age was 11 days (range 2-86 days). Half (n=38) of the infants were premature. Diagnoses included: arch obstruction (n=14), hypoplastic left heart syndrome (HLHS) (n=12), tetralogy of Fallot (ToF) or pulmonary atresia (PA)/ventricular septal defect (VSD) (n=11), transposition of the great arteries (TGA) (n=7), total anomalous pulmonary venous return (TAPVR) (n=5), and other (n=20). There were two early deaths. Follow-up was available on all infants with a median duration of 1320 days (range 6-3055 days). Cumulative Kaplan-Meier survival at one year was 90% [95% confidence interval (CI), 80-95%] and at five years was 88% (95% CI, 77-94%). Overall mortality amongst patients with genetic/chromosomal abnormalities was higher, 28% vs. 5.4% amongst patients without such abnormalities (P=0.008). Age, prematurity, preoperative mechanical ventilation, prostaglandins, non-cardiac organ dysfunction, extra-cardiac malformations, perioperative extracorporeal membrane oxygenation (ECMO), and type of procedure were not associated with significant differences in mortality. Cardiac surgery in LBW infants can be performed with low early and mid-term mortality. LBW infants with chromosomal/genetic anomalies have a higher risk.
低出生体重是新生儿及婴儿心脏手术死亡的一个危险因素。本研究的目的是确定低体重婴儿心脏手术的当代疗效及危险因素。回顾了75例连续接受心脏手术、体重<2.5 kg婴儿的记录。中位体重为2100 g（范围800 - 2500 g），中位年龄为11天（范围2 - 86天）。半数（n = 38）婴儿为早产儿。诊断包括：主动脉弓梗阻（n = 14）、左心发育不全综合征（HLHS）（n = 12）、法洛四联症（ToF）或肺动脉闭锁（PA）/室间隔缺损（VSD）（n = 11）、大动脉转位（TGA）（n = 7）、完全性肺静脉异位引流（TAPVR）（n = 5）以及其他（n = 20）。有2例早期死亡。所有婴儿均获得随访，中位随访时间为1320天（范围6 - 3055天）。1年时累积Kaplan - Meier生存率为90%[95%置信区间（CI），80 - 95%]，5年时为88%（95% CI，77 - 94%）。有基因/染色体异常的患者总体死亡率更高，分别为28%和5.4%（无此类异常的患者）（P = 0.008）。年龄、早产、术前机械通气、前列腺素、非心脏器官功能障碍、心脏外畸形、围手术期体外膜肺氧合（ECMO）及手术类型与死亡率的显著差异无关。低出生体重婴儿心脏手术可在较低的早期和中期死亡率下进行。有染色体/基因异常的低出生体重婴儿风险更高。
