Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 11:18:156-166.
doi: 10.1016/j.xjon.2024.01.006. eCollection 2024 Apr.

Survival benefits of the wait-and-grow approach in small babies (≤2000 g) requiring heart surgery

Soichiro Henmi  1 , Alyssia Venna  1 , Mitchell C Haverty  1 , Rittal Mehta  1 , Manan Desai  1 , Aybala Tongut  1 , Can Yerebakan  1 , Mary T Donofrio  2 , Ricardo A Munoz  3 , Yves d'Udekem  1
Affiliations

Survival benefits of the wait-and-grow approach in small babies (≤2000 g) requiring heart surgery

Soichiro Henmi et al. JTCVS Open. .

Abstract

Objective: The best approach to minimize the observed higher mortality of newborn infants with low birth weight who require congenital heart surgery is unclear. This retrospective study was designed to review outcomes of newborn infants weighing <2000 g who have undergone cardiovascular surgery to identify patient parameters and clinical strategies for care associated with higher survival.

Methods: A retrospective chart review of 103 patients who underwent cardiovascular surgery from 2010 to 2021 who were identified as having low birth weight (≤2000 g). Patients who underwent only patent ductus arteriosus ligation or weighing >3500 g at surgery were excluded.

Results: Median age was 24 days and weight at the time of surgery was 1920 g. Twenty-six (25%) operative mortalities were recorded. Median follow-up period was 2.7 years. The 1- and 3-year overall Kaplan-Meier survival estimate was 72.4% ± 4.5% and 69.1% ± 4.6%. The 1-year survival of patients who had a weight increase >300 g from birth to surgery was far superior to the survival of those who did not achieve such a weight gain (81.4% ± 5.6% vs 64.0% ± 6.7%; log-rank P = .04). By multivariable Cox-hazard regression analysis, the independent predictor of 1-year mortality was genetic syndrome (hazard ratio, 3.54; 95% CI, 1.67-7.82; P < .001), whereas following a strategy of increasing weight from birth to surgery resulted in lower mortality (hazard ratio, 0.49; 95% CI, 0.24-0.90; P = .02).

Conclusions: A strategy of wait and grow for newborn infants with very low birth weight requiring heart surgery results in better survival than immediate surgery provided that the patient's condition allows for this waiting period.

Keywords: cardiovascular surgery; delayed surgery; low birth weight; single ventricle.

PubMed Disclaimer

Conflict of interest statement

The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

None
Graphical abstract
None
Kaplan-Meier curves for freedom from all-cause 1-year mortality.
Figure 1
Figure 1
Kaplan-Meier curves for freedom from all-cause mortality.
Figure 2
Figure 2
Kaplan-Meier curves for freedom from all-cause 1-year mortality; the weight gain ≥300 g group and the weight gain <300 g group.
Figure 3
Figure 3
Graphical abstract. A strategy of “wait and grow” for very-low-birth-weight newborn infants requiring heart surgery results in better survival than immediate surgery provided that the patient condition allows for this waiting period. HR, Hazard ratio; CHD, congenital heart disease.
Figure E1
Figure E1
Kaplan-Meier curves for freedom from all-cause 1-year mortality; simple biventricular lesion and complex biventricular lesion.
Figure E2
Figure E2
Kaplan-Meier curves for freedom from all-cause 1-year mortality in patients who underwent surgery with cardiopulmonary bypass; the weight gain ≥300 g group and the weight gain <300 g group.
See this image and copyright information in PMC

References

    1. Chu P.Y., Li J.S., Kosinski A.S., Hornik C.P., Hill K.D. Congenital heart disease in premature infants 25-32 weeks’ gestational age. J Pediatr. 2017;181:37–41.e1. - PMC - PubMed
    1. Curzon C.L., Milford-Beland S., Li J.S., et al. Cardiac surgery in infants with low birth weight is associated with increased mortality: analysis of the Society of Thoracic Surgeons Congenital Heart Database. J Thorac Cardiovasc Surg. 2008;135:546–551. - PubMed
    1. Henmi S., Essa Y., Öztürk M., et al. Cardiovascular surgery in very low birth weight (≤1500 g) neonates. Eur J Cardiothorac Surg. 2022;63 doi: 10.1093/ejcts/ezac552. - DOI - PubMed
    1. Chang A.C., Hanley F.L., Lock J.E., Castaneda A.R., Wessel D.L. Management and outcome of low birth weight neonates with congenital heart disease. J Pediatr. 1994;124:461–466. - PubMed
    1. Marino B.S., Bird G.L., Wernovsky G. Diagnosis and management of the newborn with suspected congenital heart disease. Clin Perinatol. 2001;28:91–136. - PubMed

LinkOut - more resources