Low-weight infants are at increased mortality risk after palliative or corrective cardiac surgery

Bahaaldin Alsoufi, Cedric Manlhiot, William T. Mahle, Brian Kogon, William L. Border, Angel Cuadrado, Robert Vincent, Brian W. McCrindle, Kirk Kanter

Research output: Contribution to journalArticle

Abstract

Background Low weight is an established risk factor for mortality after congenital cardiac surgery. Given the advances in the care of neonates and infants after surgery, we sought to examine the effect of low weight on outcomes in the current era.

Results Overall, the incidence of prematurity, associated chromosomal/extracardiac abnormalities was higher in infants who weighed 2.5 kg or less than in those who weighed more than 2.5 kg; the incidence of single-ventricle pathology was comparable between the 2 groups. In addition, infants who weighed 2.5 kg or less underwent more palliation and had a higher proportion of STAT (Society of Thoracic Surgeons - European Association for Cardio-Thoracic Surgery) risk category 4 and 5 procedures. Adjusted regression models showed that low weight (≤2.5 kg) did not increase unplanned reoperation (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.48-1.67; P =.73) or extracorporeal membrane oxygenation requirement (OR, 1.23; 95% CI, 0.68-2.22; P =.49), however it was associated with significant increase in hospital mortality (OR, 2.15; 95% CI, 1.33-3.50; P =.002). In addition, there was a significant association between low weight and increased duration of postoperative mechanical ventilation and intensive care unit and hospital stays. Adjusted hazard analysis showed that weight equal to or less than 2.5 kg was associated with diminished late survival (hazard ratio, 1.89; 95% CI, 1.39-2.55; P <.001) and that was evident in all patients subgroups (P <.001 for all).

Conclusions In a large single-center series, low weight continues to be associated with increased early mortality risk and resource utilization after palliative and corrective cardiac surgery. The hazard of death in low-weight patients continues beyond the perioperative period for at least 1 year before normalizing. Strategies to improve outcomes for this high-risk population must address perioperative care, outpatient surveillance, and management.

Original languageEnglish (US)
Pages (from-to)2508-2514.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number6
DOIs
StatePublished - Dec 1 2014
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Alsoufi, B., Manlhiot, C., Mahle, W. T., Kogon, B., Border, W. L., Cuadrado, A., Vincent, R., McCrindle, B. W., & Kanter, K. (2014). Low-weight infants are at increased mortality risk after palliative or corrective cardiac surgery. Journal of Thoracic and Cardiovascular Surgery, 148(6), 2508-2514.e1. https://doi.org/10.1016/j.jtcvs.2014.07.047