Is low weight in congenital cardiac surgery still a risk factor - a retrospective single institution early mortality analysis

  • Mi-Young Cho, Department of Cardiac Surgery, Heart Center, University of Leipzig, Struempellstr. 39, 04289 Leipzig, Germany, Germany
  • Thomas Walther, Department of Cardiac Surgery, Heart Center, University of Leipzig, Struempellstr. 39, 04289 Leipzig, Germany, Germany
  • Ardawan Rastan, Department of Cardiac Surgery, Heart Center, University of Leipzig, Struempellstr. 39, 04289 Leipzig, Germany, Germany
  • Jörg Kempfert, Department of Cardiac Surgery, Heart Center, University of Leipzig, Struempellstr. 39, 04289 Leipzig, Germany, Germany
  • Friedrich Wilhelm Mohr, Department of Cardiac Surgery, Heart Center, University of Leipzig, Struempellstr. 39, 04289 Leipzig, Germany, Germany
  • Prof Martin Kostelka, Herzzentrum Leipzig, Germany

    • Objective: Due to tremendous improvements congenital cardiac surgery in neonates can be performed with reasonable results. But it is reported that low weight remains a risk factor for cardiac surgery.

    Methods: We analyzed early mortality of patients weighing 4kg and less who underwent cardiac surgery at our centre between September 1998 and February 2008. Of this total of n=564 consecutive patients we formed two groups according to their weight. Group1 included patients weighing less or equal 2.5kg (n=87) and was compared with Group2 with weight at operation 2.6 to 4kg (n=477). Furthermore we analyzed the predictive value of the Aristotle Basic Complexity scores.

    Results: Overall n=23 (4%) died early, whereas the early mortality in this challenging Group1 was 10.3% (14.8% on-pump, 3% off-pump)compared to Group2 with 2.9% (3.4% on-pump, 1% off-pump). Median age were nearly the same with 11d rather 12d. Higher mortality was associated with extended bypass time. Early mortality was high after palliation in Group1 n=7 (22.6% of all palliations), compared to Group2 n=6 (5.6%). The highest mortality was recognizeable in Group1 with functional single ventricle after on-pump palliation (40%). 22% of infants in Group1 with with the highest Aristotle Complexity Score 4 died early in comparison just 3% in Group2 with the same scoring.

    Conclusion: Congenital cardiac surgery in low weight infants can be performed with reasonable results but with elevated mortality compared to normal weight patients. Especially on-pump palliation in single ventricle morphology is associated with higher mortality in low weight neonates.