title: Cardiac surgery of premature and low birthweight newborns: is a change of fate possible?
abstract: Low birthweight (LBW) continues to be a high-risk factor in surgery for congenital heart disease. This risk is particularly very high in very low birthweight infants under 1500g and extremely LBW infants under 1000g. From January 2005 to December 2008, 33 consecutive LBW neonates underwent cardiac surgery in our clinic in keeping with the criteria for choice of surgery. Their weight range was between 800 and 1900g. Nine of them were under 1000g. Cardiopulmonary bypass (CPB) was used in 17 patients (39.5%) and pulsatile perfusion mode was applied to patients in the CPB group. The same surgical team operated to achieve palliation (8 patients, 24.2%) or full repair (25 patients, 75.8%). Median gestational age was 36 weeks with 12 (36.4%) premature babies (≤37 weeks). Median age at operation was 5 days. Pathologies were single ventricle (n=3), pulmonary atresia-ventricular septal defect (n=3), aortic coarctation (n=10), aorticopulmonary window and interrupted aortic arch combination (n=6), patent arterial duct (n=11), critical aortic stenosis (n=8), and tetralogy of Fallot with pulmonary atresia (n=2). One infant had VATER syndrome. Selective cerebral perfusion technique was used in complex arch pathologies for cerebral protection. Median follow-up was 14 months. There were four early postoperative deaths. None of the cases showed a need for early reoperation. The acceptable early- and midterm mortality rates in this group suggest that these operations can be successfully performed. There is a need for further multicenter studies to evaluate these high-risk groups.
authors.affiliation: Department of Cardiovascular Surgery, V.K.V. American Hospital.
authors.forename: Tijen
authors.initials: T
authors.lastname: Alkan-Bozkaya
authors.forename: Halil
authors.initials: H
authors.lastname: Türkoğlu
authors.forename: Atif
authors.initials: A
authors.lastname: Akçevin
authors.forename: Tufan
authors.initials: T
authors.lastname: Paker
authors.forename: Hilda
authors.initials: H
authors.lastname: Ozkan-Çerçi
authors.forename: Aygün
authors.initials: A
authors.lastname: Dindar
authors.forename: Cihangir
authors.initials: C
authors.lastname: Ersoy
authors.forename: Vedat
authors.initials: V
authors.lastname: Bayer
authors.forename: Demet
authors.initials: D
authors.lastname: Aşkin
authors.forename: Akif
authors.initials: A
authors.lastname: Undar
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007226:Infant Mortality; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D018579:Patient Selection; D010414:Pennsylvania; D010477:Perfusion; D011673:Pulsatile Flow; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome