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J Thorac Cardiovasc Surg 1998;116:28-32
© 1998 Mosby, Inc.

Surgery For Congenital Heart Disease

The outcome of cardiac operations in infants weighing two kilograms or less

From the Departments of Pediatrics and Cardiothoracic Surgery, The Mount Sinai Medical Center, New York, N.Y.

Received for publication Oct. 22, 1997. Revisions requested Jan. 5, 1998. Revisions received Feb. 27, 1998. Accepted for publication March 2, 1998. Reprint requests: Anthony F. Rossi, MD, Division of Pediatric Cardiology, The Mount Sinai Medical Center, Box 1201, 1 Gustave Levy Place, New York, N.Y 11029.

Objective: A review of our recent experience of operating on infants weighing 2 kg or less who had congenital heart disease was performed to determine the outcome of early surgical repair or palliation.
Methods: A retrospective review of hospital records was performed for infants who weighed 2 kg or less and who were identified to have undergone cardiac operation at our institution January 1992 to June 1997. The data collected included age, weight, gestational age, cardiac diagnosis, surgical procedure, and outcome measures such as length of stay, morbidity, and mortality rate. Outpatient charts were reviewed for follow-up survival and cardiac status.
Results: Thirty-three operations were performed on 30 patients. Median age at operation was 19.5 days (1 to 140 days), and median weight was 1.8 kg (1.1 to 2.0 kg). Cardiac diagnoses varied, with coarctation of the aorta and tetralogy of Fallot most common. Twenty-four patients were born at 37 or fewer weeks' gestation. Hospital survival was 83% with no difference in mortality rates based on age, weight, or type of surgical procedure. Premature infants tended to have worse hospital survival. Median postoperative length of stay was 39 days (6 to 122 days). Median duration of mechanical ventilation in survivors was 6 days (2 to 24 days). Neurologic complications were documented in eight patients. Of the 25 hospital survivors, 20 (80%) are alive with good cardiac status at a mean follow-up of 13 months.
Conclusion: Cardiac operations in a selected group of infants weighing 2 kg or less can provide acceptable hospital survival. In most instances, complete repair is possible with good medium-term outcome in the survivors. Investigation into neurologic outcomes in these patients is warranted. (J Thoracic Cardiovasc Surg 1998;116:28-32)

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