Survival benefits of the wait-and-grow approach in small babies (≤2000 g) requiring heart surgery

Authors

Soichiro Henmi, Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC.
Alyssia Venna, Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC.
Mitchell C. Haverty, Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC.
Rittal Mehta, Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC.
Manan Desai, Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC.
Aybala Tongut, Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC.
Can Yerebakan, Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC.
Mary T. Donofrio, Department of Cardiology, Heart Institute, Children's National Hospital, George Washington University, Washington, DC.
Ricardo A. Munoz, Department of Cardiac Critical Care, Heart Institute, Children's National Hospital, George Washington University, Washington, DC.
Yves d'Udekem, Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC.

Document Type

Journal Article

Publication Date

4-1-2024

Journal

JTCVS open

Volume

18

DOI

10.1016/j.xjon.2024.01.006

Keywords

cardiovascular surgery; delayed surgery; low birth weight; single ventricle

Abstract

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

APA Citation

Henmi, Soichiro; Venna, Alyssia; Haverty, Mitchell C.; Mehta, Rittal; Desai, Manan; Tongut, Aybala; Yerebakan, Can; Donofrio, Mary T.; Munoz, Ricardo A.; and d'Udekem, Yves, "Survival benefits of the wait-and-grow approach in small babies (≤2000 g) requiring heart surgery" (2024). GW Authored Works. Paper 4782.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4782

Department

Surgery