Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC, USA.
Eur J Cardiothorac Surg. 2022 Dec 2;63(1). doi: 10.1093/ejcts/ezac552.
Low birth weight and prematurity are known risks of increased morbidity and mortality with undergoing cardiovascular surgery. Our aim was to review the outcomes of very low birth weight (≤1500 g) patients who have undergone cardiovascular surgery.
A retrospective review was performed for 32 very low birth weight (≤1500 g) patients who underwent cardiovascular surgery from 2004 to 2021 in our institution.
Fifteen patients weighting ≤1500 g at surgery (≤1500-g group) were compared to 17 patients born with a weigh of ≤1500 g and weighting between 1500 and 2500 g at surgery (>1500- to ≤2500-g group) in this study. In-hospital mortality was 33% (5/15) in the ≤1500-g group and 24% (4/17) in the >1500- to ≤2500-g group (P = 0.55). All patients with simple biventricular lesion survived following full repair. The occurrence of postoperative intracerebral haemorrhage was significantly higher in those operated at weight ≤1500 g than those weighting >1500 to ≤2500 g (40% vs 0%; P = 0.01). The 1- and 3-year survival rates were 66.0 ± 12.4% and 46.2 ± 14.8% in the ≤1500-g group and 76.5 ± 10.3% and 70.6 ± 11.1% in the >1500- to ≤2500-g group (log-rank P = 0.12).
Cardiac surgery for a very low birth weight neonate resulted in a high early and late mortality. Early surgery is only acceptable for simple biventricular lesions if needed. Delayed surgery seems to provide better long-term outcomes in patients with complex lesions. Alternative strategies for neonatal cardiopulmonary bypass should be investigated in patients with complex biventricular and single ventricular lesions.
低出生体重和早产是接受心血管手术的发病率和死亡率增加的已知风险。我们的目的是回顾在我们机构接受心血管手术的极低出生体重（≤1500g）患者的结局。
对 2004 年至 2021 年在我院接受心血管手术的 32 例极低出生体重（≤1500g）患者进行回顾性分析。
本研究将手术时体重≤1500g 的 15 例患者（≤1500-g 组）与手术时体重≤1500g 但出生时体重在 1500g 至 2500g 之间的 17 例患者（＞1500 至≤2500-g 组）进行比较。≤1500-g 组的院内死亡率为 33%（5/15），＞1500 至≤2500-g 组为 24%（4/17）（P=0.55）。所有接受单纯双心室病变完全修复的患者均存活。与体重＞1500 至≤2500g 的患者相比，体重≤1500g 的患者术后颅内出血的发生率明显更高（40% vs 0%；P=0.01）。≤1500-g 组的 1 年和 3 年生存率分别为 66.0±12.4%和 46.2±14.8%，＞1500 至≤2500-g 组分别为 76.5±10.3%和 70.6±11.1%（对数秩检验 P=0.12）。
极低出生体重新生儿的心脏手术导致早期和晚期死亡率均较高。如果需要，早期手术仅适用于单纯双心室病变。对于复杂病变的患者，延迟手术似乎提供了更好的长期结局。对于复杂双心室和单心室病变的患者，应研究新生儿心肺转流的替代策略。
