Division of Neonatology, Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY.
Division of Pediatric & Congenital Cardiac Surgery, Department of Surgery, New York-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY.
J Thorac Cardiovasc Surg. 2023 Jun;165(6):2204-2211.e4. doi: 10.1016/j.jtcvs.2022.06.013. Epub 2022 Jun 28.
Prematurity is a risk factor for in-hospital mortality after cardiac surgery. The structure of intensive care unit models designed to deliver optimal care to neonates including those born preterm with critical congenital heart disease is unknown. The objective of this study was to evaluate in-hospital outcomes after cardiac surgery across gestational ages in an institution with a dedicated neonatal cardiac program.
This study is a single-center, retrospective review of infants who underwent cardiac surgical interventions from our dedicated neonatal cardiac intensive care program between 2006 and 2017. We evaluated in-hospital mortality and morbidity rates across all gestational ages.
A total of 1238 subjects met inclusion criteria over a 11-year period. Overall in-hospital mortality after cardiac surgery was 6.1%. The mortality rate in very preterm infants (n = 68; <34 weeks' gestation at birth) was 17.6% (odds ratio, 3.52 [1.4-8.53]), versus 4.3% in full-term (n = 563; 39-40 weeks) referent/control infants. Very preterm infants with isolated congenital heart disease (without evidence of other affected organ systems) experienced a mortality rate of 10.5% after cardiac surgery. Neither the late preterm (34-36 weeks) nor the early term (37-38 ) groups had significantly increased odds of mortality compared with full-term infants. Seventy-eight percent of very preterm infants incurred a preoperative or postoperative complication (odds ratio, 4.78 [2.61-8.97]) compared with 35% of full-term infants.
In this study of a single center with a dedicated neonatal cardiac program, we report some of the lowest mortality and morbidity rates after cardiac surgery in preterm infants in the recent era. The potential survival advantage of this model is most striking for very preterm infants born with isolated congenital heart disease.
早产是心脏手术后院内死亡的一个危险因素。为患有临界先天性心脏病的早产儿提供最佳护理的重症监护病房模式的结构尚不清楚。本研究的目的是评估在设有专门新生儿心脏计划的机构中，根据胎龄，在心脏手术后的院内结局。
这是一项单中心、回顾性研究，纳入了 2006 年至 2017 年期间在我们的专门新生儿心脏重症监护病房接受心脏手术干预的婴儿。我们评估了所有胎龄的院内死亡率和发病率。
在 11 年的时间里，共有 1238 名患者符合纳入标准。心脏手术后院内总死亡率为 6.1%。非常早产儿（n=68；出生时胎龄<34 周）的死亡率为 17.6%（优势比，3.52[1.4-8.53]），而足月儿（n=563；39-40 周）的参考/对照婴儿的死亡率为 4.3%。患有单纯先天性心脏病（无其他受影响器官系统证据）的非常早产儿在心脏手术后的死亡率为 10.5%。与足月儿相比，晚期早产儿（34-36 周）和早期早产儿（37-38 周）的死亡率均无显著增加。78%的非常早产儿在术前或术后发生并发症（优势比，4.78[2.61-8.97]），而只有 35%的足月儿发生并发症。
在这项研究中，我们报告了在最近一个时期，患有先天性心脏病的非常早产儿的心脏手术后死亡率和发病率较低。该模型的潜在生存优势在患有单纯先天性心脏病的非常早产儿中最为明显。
