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J Thorac Cardiovasc Surg 1999;117:324-331
© 1999 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

RESULTS OF 102 CASES OF COMPLETE REPAIR OF CONGENITAL HEART DEFECTS IN PATIENTS WEIGHING 700 TO 2500 GRAMS

V. Mohan Reddy, MDa, Doff B. McElhinney, MDa, Theresa Sagrado, BAa, Andrew J. Parry, MDa, David F. Teitel, MDb, Frank L. Hanley, MDa

From the Divisions of Cardiothoracic Surgerya and Pediatric Cardiology,b University of California–San Francisco, San Francisco, Calif.

Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.

Received for publication May 26, 1998. revisions requested July 6, 1998. revisions received Sept 23, 1998. Accepted for publication Oct 15, 1998. Address for reprints: V. Mohan Reddy, MD, Division of Cardiothoracic Surgery, 505 Parnassus Ave, M593, San Francisco, CA 94143-0118.

Background: Published data suggest that low birth weight is a risk factor for poor outcome in corrective surgery for many cardiac defects. Congenital heart defects in low birth weight infants are typically managed with supportive therapy or palliative operations, with definitive repair delayed. The morbidity associated with such approaches is high.
Methods: Since 1990 complete repair of congenital heart defects (other than patent ductus arteriosus) has been performed in 102 infants no larger than 2500 g (median 2100 g, range 700-2500 g), including 16 no larger than 1500 g. Defects included ventricular septal defect (n = 22), tetralogy of Fallot complexes (n = 20), transposition complexes (n = 13), aortic coarctation (n = 12), interrupted arch (n = 10), truncus arteriosus (n = 8), atrioventricular septal defect (n = 6), total anomalous pulmonary venous return (n = 5), and other (n = 6). Results: Preoperative morbidity was more common among patients referred late for surgical correction. There were 10 early deaths (10%) attributable to cardiac failure (n = 4), arrhythmia (n = 1), multiorgan failure (n = 1), sepsis (n = 1), idiopathic coronary artery intimal necrosis (n = 1), foot gangrene (n = 1), and pulmonary hemorrhage (n = 1). No patient had postbypass intracerebral hemorrhage. At follow-up (median 36 months) there were 8 late deaths, and 8 patients underwent 10 reinterventions. There was no evidence of neurologic sequelae attributable to the operation.
Conclusions: In general, delaying repair of congenital heart defects in low birth weight infants does not confer a benefit and is associated with higher preoperative morbidity. Complete repair of both simple and complex lesions can be achieved in such cases with good results. Growth after repair approximates the normal curve for low birth weight infants without heart disease. It is recommended that such infants, especially when they have symptoms, undergo early surgical repair rather than prolonged medical management or other forms of palliation.




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