title: Outcomes of cardiac surgery in patients weighing <2.5 kg: affect of patient-dependent and -independent variables.
abstract: OBJECTIVE
  A recent Society of Thoracic Surgeons database study showed that low weight (<2.5 kg) at surgery was associated with high operative mortality (16%). We sought to assess the outcomes after cardiac repair in patients weighing <2.5 kg versus 2.5 to 4.5 kg in an institution with a dedicated neonatal cardiac program and to determine the potential role played by prematurity, the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) risk categories, uni/biventricular pathway, and surgical timing.
  
  
  METHODS
  We analyzed the outcomes (hospital mortality, early reintervention, postoperative length of stay, mortality [at the last follow-up point]) in patients weighing <2.5 kg at surgery (n = 146; group 1) and 2.5 to 4.5 kg (n = 622; group 2), who had undergone open or closed cardiac repairs from January 2006 to December 2012 at our institution. The statistical analysis was stratified by prematurity, STAT risk category, uni/biventricular pathway, and usual versus delayed surgical timing. Univariate versus multivariate risk analysis was performed. The mean follow-up was 21.6 ± 25.6 months.
  
  
  RESULTS
  Hospital mortality in group 1 was 10.9% (n = 16) versus 4.8% (n = 30) in group 2 (P = .007). The postoperative length of stay and early unplanned reintervention rate were similar between the 2 groups. Late mortality in group 1 was 0.7% (n = 1). In group 1, early outcomes were independent of the STAT risk category, uni/biventricular pathway, or surgical timing compared with group 2. A lower gestational age at birth was an independent risk factor for early mortality in group 1.
  
  
  CONCLUSIONS
  A dedicated multidisciplinary neonatal cardiac program can yield good outcomes for neonates and infants weighing <2.5 kg independently of the STAT risk category and uni/biventricular pathway. A lower gestational age at birth was an independent risk factor for hospital mortality.
authors.affiliation: Division of Pediatric Cardiac Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
authors.forename: David
authors.initials: D
authors.lastname: Kalfa
authors.affiliation: Division of Neonatology, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
authors.forename: Ganga
authors.initials: G
authors.lastname: Krishnamurthy
authors.affiliation: Division of Neonatology, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Duchon
authors.affiliation: Division of Pediatric Cardiac Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
authors.forename: Marc
authors.initials: M
authors.lastname: Najjar
authors.affiliation: Division of Pediatric Cardiology, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Levasseur
authors.affiliation: Division of Pediatric Cardiac Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
authors.forename: Paul
authors.initials: P
authors.lastname: Chai
authors.affiliation: Division of Pediatric Cardiac Surgery, Seattle Children's Hospital, University of Washington, Seattle, Wash.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chen
authors.affiliation: Division of Pediatric Cardiac Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
authors.forename: Jan
authors.initials: J
authors.lastname: Quaegebeur
authors.affiliation: Division of Pediatric Cardiac Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY. Electronic address: eb2709@cumc.columbia.edu.
authors.forename: Emile
authors.initials: E
authors.lastname: Bacha
mesh_terms: D000367:Age Factors; D001724:Birth Weight; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D016009:Chi-Square Distribution; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D009519:New York City; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome