Cardiac surgery in infants with low weight is associated with increased mortality: An analysis of the Society of Thoracic Surgeons Congenital Heart Database
Christopher L. Curzon1, Sarah Milford-Beland2, Jennifer S. Li1, Sean M. O'Brien2, Jeffrey P. Jacobs4, Marshall L. Jacobs5, Karl F. Welke6, Andrew J. Lodge3, Eric D. Peterson2, James Jaggers3; 1Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC; 2Duke Clinical Research Institute, Durham, NC; 3Division of Pediatric Cardiovascular Surgery, Duke University Medical Center, Durham, NC; 4The Congenital Heart Institute of Florida, University of South Florida, All Children's Hospital, Children's Hospital of Tampa, Tampa, FL; 5Division of Pediatric Cardiovascular Surgery, St. Christopher's Hospital for Children, Philadelphia, PA; 6Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, OR
Objective: While outcomes for repair of neonatal CHD have improved significantly over the last 10 years, low weight infants remain a challenging population. Despite recent single institution reports of improved survival in this difficult group, the significance of weight as a risk factor for mortality remains unclear. We sought to evaluate the hypothesis that low weight infants have increased operative mortality by utilization of the Society of Thoracic Surgeons (STS) Congenital Database.Methods: We analyzed mortality in all infants ages 0-90 days, weighing 1-2.5 kg, (n=517) and 2.5-4 kg, (n=2505) who underwent cardiac surgery from 2002-2004 at 32 participating centers. Patients were grouped according to primary procedure performed and analyzed according to weight at time of surgical intervention. Patients were also analyzed according to Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) level and Aristotle Basic Complexity score (ABC).
Results: Outcomes for 3022 infants were analyzed according to the primary cardiovascular procedure. For infants <2.5kg there was a significant increase in mortality in patients undergoing TAPVC repair, arterial switch procedure, systemic to pulmonary artery shunt and the Norwood procedure. Increased mortality was also associated with low weight in infants with RACHS-1 levels 2-6 and with ABC levels 2-4.
Conclusion: Analysis of the STS Congenital Database reveals that low weight at time of surgery is associated with increased mortality in patients undergoing several types of cardiovascular procedures. These data do not allow assessment of specific risks or benefits of any particular treatment strategy. However, these data support the need for prospective analysis of treatment strategies for these high risk patients.
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