Henmi Soichiro, Venna Alyssia, Haverty Mitchell C, Mehta Rittal, Desai Manan, Tongut Aybala, Yerebakan Can, Donofrio Mary T, Munoz Ricardo A, d'Udekem Yves
Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC.
Department of Cardiology, Heart Institute, Children's National Hospital, George Washington University, Washington, DC.
JTCVS Open. 2024 Jan 11;18:156-166. doi: 10.1016/j.xjon.2024.01.006. eCollection 2024 Apr.
The best approach to minimize the observed higher mortality of newborn infants with low birth weight who require congenital heart surgery is unclear. This retrospective study was designed to review outcomes of newborn infants weighing <2000 g who have undergone cardiovascular surgery to identify patient parameters and clinical strategies for care associated with higher survival.
A retrospective chart review of 103 patients who underwent cardiovascular surgery from 2010 to 2021 who were identified as having low birth weight (≤2000 g). Patients who underwent only patent ductus arteriosus ligation or weighing >3500 g at surgery were excluded.
Median age was 24 days and weight at the time of surgery was 1920 g. Twenty-six (25%) operative mortalities were recorded. Median follow-up period was 2.7 years. The 1- and 3-year overall Kaplan-Meier survival estimate was 72.4% ± 4.5% and 69.1% ± 4.6%. The 1-year survival of patients who had a weight increase >300 g from birth to surgery was far superior to the survival of those who did not achieve such a weight gain (81.4% ± 5.6% vs 64.0% ± 6.7%; log-rank = .04). By multivariable Cox-hazard regression analysis, the independent predictor of 1-year mortality was genetic syndrome (hazard ratio, 3.54; 95% CI, 1.67-7.82; < .001), whereas following a strategy of increasing weight from birth to surgery resulted in lower mortality (hazard ratio, 0.49; 95% CI, 0.24-0.90; = .02).
A strategy of wait and grow for newborn infants with very low birth weight requiring heart surgery results in better survival than immediate surgery provided that the patient's condition allows for this waiting period.
对于需要进行先天性心脏病手术的低出生体重新生儿，如何采取最佳方法将观察到的较高死亡率降至最低尚不清楚。本回顾性研究旨在回顾体重<2000g且接受了心血管手术的新生儿的治疗结果，以确定与较高生存率相关的患者参数和临床护理策略。
对2010年至2021年间接受心血管手术且被确定为低出生体重（≤2000g）的103例患者进行回顾性病历审查。仅接受动脉导管未闭结扎术或手术时体重>3500g的患者被排除。
中位年龄为24天，手术时体重为1920g。记录到26例（25%）手术死亡。中位随访期为2.7年。1年和3年的总体Kaplan-Meier生存率估计分别为72.4%±4.5%和69.1%±4.6%。从出生到手术体重增加>300g的患者1年生存率远高于未实现这种体重增加的患者（81.4%±5.6%对64.0%±6.7%；对数秩检验P=0.04）。通过多变量Cox风险回归分析，1年死亡率的独立预测因素是遗传综合征（风险比，3.54；95%置信区间，1.67-7.82；P<0.001），而从出生到手术采取增加体重的策略可降低死亡率（风险比，0.49；95%置信区间，0.24-0.90；P=0.02）。
对于需要心脏手术的极低出生体重新生儿，只要患者病情允许等待期，采取等待并生长的策略比立即手术能带来更好的生存率。
