Cardiovascular surgery in very low birth weight (≤ 1500g) neonates.

Abstract

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 ≤ 1500 g and weighting between 1500 g and 2500 g at surgery (>1500 g to ≤ 2500 g group) in this study. In-hospital mortality was 33% (5/15) in ≤ 1500 g group and 24% (4/17) in > 1500 g 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 g 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 ≤ 1500 g group and 76.5 ± 10.3% and 70.6 ± 11.1% in > 1500 g to ≤ 2500 g group (Log-rank p = 0.12). Cardiac surgery for very low birth weight neonate resulted in a high early and late mortality. Early surgery is only acceptable for simple biventricular lesion if needed. Delayed surgery seems to provide better long-term outcomes in patients with complex lesions. Alternative strategies to neonatal cardiopulmonary bypass should be investigated in patients with complex biventricular and single ventricle lesions.