title: Critical Congenital Heart Diseases in Preterm Neonates: Is Early Cardiac Surgery Quite Reasonable?
abstract: Prematurity is a recognized risk factor for morbidity and mortality following cardiac surgery. Postoperative and long-term outcomes after cardiac surgery performed in the preterm period are poorly described. The aim of this study was to analyze a population of preterm neonates operated on for critical congenital heart disease (CHD) before 37 weeks of gestational age (wGA) with special attention given to early and late mortality and morbidity. Between 2000 and 2013, 28 preterm neonates (median gestational age (GA) 34.3 weeks) underwent cardiopulmonary bypass (CPB) surgery for critical CHD before 37 wGA; records were retrospectively reviewed. All patients except three with single ventricle physiology had a single-stage anatomic repair. Overall mortality was 43 % (95 % CI 25-62). Risk factors for death were birth weight (p = 0.032) and weight at surgery (p = 0.037), independently of GA, preoperative status, CPB and aortic clamp time. Seven patients, including those with univentricular hearts, died during the postoperative period, and five in the first year after surgery. Median follow-up was 5.9 years (range 1 month-12.8 years). Kaplan-Meier survival rate was 75 % (95 % CI 59-91) at 1 month, and 57 % (95 % CI 39-75) at 1 and 5 years. Eight patients required reoperations after a delay of 2.8 ± 1.3 months; eight had bronchopulmonary dysplasia. At the end of follow-up, nine patients were asymptomatic. One-stage biventricular repair for critical CHD on preterm neonates was feasible. Mortality remained high but acceptable, mainly confined to the first postoperative year and related to small weight. Despite reoperations, long-term clinical status was good in most survivors. Further long-term prospective investigations are necessary to evaluate neurodevelopmental outcomes.
authors: Pôle des Cardiopathies Congénitales, Centre Chirurgical Marie Lannelongue, 133, avenue de la Résistance, 92350, Le Plessis-Robinson, France, camilledollat@hotmail.fr.
authors: Camille
authors: C
authors: Dollat
authors: Mathieu
authors: M
authors: Vergnat
authors: Daniela
authors: D
authors: Laux
authors: Bertrand
authors: B
authors: Stos
authors: Alban
authors: A
authors: Baruteau
authors: André
authors: A
authors: Capderou
authors: Serge
authors: S
authors: Demontoux
authors: Michel
authors: M
authors: Hamann
authors: Emir
authors: E
authors: Mokhfi
authors: Isabelle
authors: I
authors: Van Aerschot
authors: Régine
authors: R
authors: Roussin
authors: Emmanuel
authors: E
authors: Le Bret
authors: Mohamed
authors: M
authors: Ly
authors: Emre
authors: E
authors: Belli
authors: Virginie
authors: V
authors: Lambert
mesh_terms: D001724:Birth Weight; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality*; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome