JTCVS Open (Apr 2024)

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

  • Soichiro Henmi, MD, PhD,
  • Alyssia Venna, MBS,
  • Mitchell C. Haverty, MS,
  • Rittal Mehta, MS, BDS,
  • Manan Desai, MD,
  • Aybala Tongut, MD,
  • Can Yerebakan, MD,
  • Mary T. Donofrio, MD,
  • Ricardo A. Munoz, MD,
  • Yves d’Udekem, MD

Journal volume & issue
Vol. 18
pp. 156 – 166

Abstract

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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 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.

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