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Critical Congenital Heart Diseases in Preterm Neonates: Is Early Cardiac Surgery Quite Reasonable?

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Abstract

Prematurity is a recognized risk factor for morbidity and mortality following cardiac surgery. Postoperative and long-term outcomes after cardiac surgery performed in the preterm period are poorly described. The aim of this study was to analyze a population of preterm neonates operated on for critical congenital heart disease (CHD) before 37 weeks of gestational age (wGA) with special attention given to early and late mortality and morbidity. Between 2000 and 2013, 28 preterm neonates (median gestational age (GA) 34.3 weeks) underwent cardiopulmonary bypass (CPB) surgery for critical CHD before 37 wGA; records were retrospectively reviewed. All patients except three with single ventricle physiology had a single-stage anatomic repair. Overall mortality was 43 % (95 % CI 25–62). Risk factors for death were birth weight (p = 0.032) and weight at surgery (p = 0.037), independently of GA, preoperative status, CPB and aortic clamp time. Seven patients, including those with univentricular hearts, died during the postoperative period, and five in the first year after surgery. Median follow-up was 5.9 years (range 1 month–12.8 years). Kaplan–Meier survival rate was 75 % (95 % CI 59–91) at 1 month, and 57 % (95 % CI 39–75) at 1 and 5 years. Eight patients required reoperations after a delay of 2.8 ± 1.3 months; eight had bronchopulmonary dysplasia. At the end of follow-up, nine patients were asymptomatic. One-stage biventricular repair for critical CHD on preterm neonates was feasible. Mortality remained high but acceptable, mainly confined to the first postoperative year and related to small weight. Despite reoperations, long-term clinical status was good in most survivors. Further long-term prospective investigations are necessary to evaluate neurodevelopmental outcomes.

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Abbreviations

BPD:

Bronchopulmonary dysplasia

CPB:

Cardiopulmonary bypass

CHD:

Congenital heart disease

ECMO:

Extracorporeal membrane oxygenation

GA:

Gestational age

IQR:

Interquartile range

IVH:

Intraventricular hemorrhage

LBW:

Low birth weight

NEC:

Necrotizing enterocolitis

NYHA:

New York Heart Association

PVL:

Periventricular leukomalacia

ROP:

Retinopathy of prematurity

SGA:

Small for gestational age

wGA:

Weeks of gestational age

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Acknowledgments

We gratefully acknowledge Elodie Gouadon, Françoise Lhomme and Maxime Brière for their technical assistance.

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    Authors and Affiliations

    1. Pôle des Cardiopathies Congénitales, Centre Chirurgical Marie Lannelongue, 133, avenue de la Résistance, 92350, Le Plessis-Robinson, France

      Camille Dollat, Mathieu Vergnat, Daniela Laux, Bertrand Stos, Alban Baruteau, Serge Demontoux, Michel Hamann, Emir Mokhfi, Isabelle Van Aerschot, Régine Roussin, Emmanuel Le Bret, Mohamed Ly, Emre Belli & Virginie Lambert

    2. DHU Thorax Innovation, Université Paris Sud, 94276, Le Kremlin-Bicêtre Cedex, France

      André Capderou & Virginie Lambert

    3. Département de Recherche Médicale, Centre Chirurgical Marie Lannelongue, Inserm, UMR_S999, LabEx LERMIT, 92350, Le Plessis-Robinson, France

      André Capderou & Virginie Lambert

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    1. Camille Dollat
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    Correspondence to Camille Dollat.

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    Virginie Lambert and Emre Belli equally contributed to the article.

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    Dollat, C., Vergnat, M., Laux, D. et al. Critical Congenital Heart Diseases in Preterm Neonates: Is Early Cardiac Surgery Quite Reasonable?. Pediatr Cardiol 36, 1279–1286 (2015). https://doi.org/10.1007/s00246-015-1158-9

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    • DOI: https://doi.org/10.1007/s00246-015-1158-9

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