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
Affiliations
Soichiro Henmi, MD, PhD
Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
Alyssia Venna, MBS
Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
Mitchell C. Haverty, MS
Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
Rittal Mehta, MS, BDS
Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
Manan Desai, MD
Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
Aybala Tongut, MD
Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
Can Yerebakan, MD
Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
Mary T. Donofrio, MD
Department of Cardiology, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
Ricardo A. Munoz, MD
Department of Cardiac Critical Care, Heart Institute, Children's National Hospital, George Washington University, Washington, DC
Yves d’Udekem, MD
Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, George Washington University, Washington, DC; Address for reprints: Yves d’Udekem, MD, Department of Pediatric Cardiac Surgery, Heart Institute, Children's National Hospital, 111 Michigan Ave NW, Suite WW 400, Washington, DC 20010.
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.
