Key result
Low body weight linked to ~6-fold higher in-hospital mortality after RACHS-1 category 3 congenital cardiac surgery.
Why the study?
Cardiac surgery outcomes in patients with low body weight are mainly reported from Western centers, with limited data from Asian populations.
Does low body weight (<2,500g) increase the risk of hospital mortality in neonates and infants undergoing cardiac surgery compared to those with larger body weight?
Observational (n=1,245)
No
Does low body weight (<2,500g) increase the risk of hospital mortality in neonates and infants undergoing cardiac surgery compared to those with larger body weight?
Cardiac surgery in infants weighing <2,500g carries a higher risk of hospital mortality, particularly in RACHS-1 categories 3 and 4, compared to larger infants.
May warrant closer monitoring of low-weight infants in RACHS-1 categories 3-4; leaves open whether targeted strategies reduce mortality.
BACKGROUND: Cardiac surgery performed in patients with low body weight is a challenge for surgeons. Currently, such outcomes are mainly reported from European or North American centers. In this study, we review our cardiac surgery experience with neonates and infants weighing <2,500g. METHODS AND RESULTS: We included patients with a body weight <2,500g who received cardiac surgery between January 2008 and December 2012. The survival outcome was compared to that of patients with large body weight, and then the Risk Adjusted Classification for Congenital Heart Surgery (RACHS-1) categorization was used for operative risk stratification. In the 1,245 index operations, 53 patients (4.3%) were <2,500g. The mean body weight was 2,232g (range 1,320-2,500g). The hospital mortality rate was 20.7% (11/53). Most (85%) of the procedures were in RACHS-1 category ≥3. The risk ratio was significantly higher in RACHS-1 category 3 (relative risk [RR]:6.2; 95% confidence interval [CI]:1.6-23.9) and 4 (RR:4.6; 95% CI:1.4-15.0), respectively, while it was not significantly different in category 2 (RR:1.02; 95% CI:1.01-1.02) and category 6 (RR:2.9; 95% CI:0.36-13.3). CONCLUSIONS: Cardiac surgery performed on infants with low body weight is generally a complex procedure, but the results are acceptable. The risk was higher than that for patients with higher body weight in RACHS-1 category 3 and 4. Further investigation to improve the outcome of this high-risk group is needed.
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Chen et al. (2013) conducted an observational in Congenital heart defects requiring cardiac surgery (n=1,245). Low body weight (<2,500 g) vs. Body weight >2,500 g was evaluated on In-hospital mortality for RACHS-1 category 3 procedures (RR 6.2, 95% CI 1.6-23.9, p=0.024). In infants undergoing congenital cardiac surgery, low body weight (<2,500 g) was associated with a significantly higher risk of in-hospital mortality compared to larger infants for RACHS-1 category 3 (RR 6.2) and category 4 (RR 4.6) procedures.
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