Surgical Considerations and Management Options in Premature and Very Low Birth Weight Infants With Complex Congenital Heart Disease

Abstract

The purpose of this review is to provide a concise discussion regarding surgical management of infants born pre-term and/or of low birth weight with congenital heart disease (CHD). The following provides a summary of current available experiential data and treatment paradigms that remain in evolution for this high-risk subset of infants. The composite of these findings supports center- and patient-specific decision-making to define the optimal timing and technique utilized for the palliation and definitive surgical treatment of CHD across a spectrum of severity. The following establishes that infants born both pre-term and of low birth weight represent a high-risk surgical cohort with CHD. Despite this increased risk of both morbidity and mortality following surgical palliation or definitive anatomic correction, advancements in prenatal diagnostics, in postnatal resuscitation, and in the conduct of complex neonatal surgery and cardiopulmonary bypass now enable early intervention with improved outcomes and favorable long-term risk of need for re-intervention. Infants of low birth weight and those born pre-term represent a high-risk subset of patients with CHD. Advancements in both surgical technique and the advent of interventional therapies have introduced important considerations that have enabled earlier treatment in a subset of carefully selected patients. Further prospective, well-controlled data are needed to better define the multi-system effects of early surgical intervention in this high-risk patient population.