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Jeffrey Phillip Jacobs
Marshall Lewis Jacobs
Karl F. Welke
Andrew J. Lodge
Eric D. Peterson
James Jaggers
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J Thorac Cardiovasc Surg 2008;135:546-551
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Cardiac surgery in infants with low birth weight is associated with increased mortality: Analysis of the Society of Thoracic Surgeons Congenital Heart Database

Christopher L. Curzon, DOa, Sarah Milford-Beland, MSb, Jennifer S. Li, MD, MHSa,b, Sean M. O'Brien, PhDb, Jeffrey Phillip Jacobs, MDc, Marshall Lewis Jacobs, MDd, Karl F. Welke, MDe, Andrew J. Lodge, MDf, Eric D. Peterson, MD, MPHb, James Jaggers, MDf,*

a Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC
b Duke Clinical Research Institute, Durham, NC
c Congenital Heart Institute of Florida (CHIF), University of South Florida, All Children's Hospital
d Pediatric Cardiovascular Surgery, St Christopher's Hospital for Children, Philadelphia, Pa
e Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, Ore
f Division of Cardiovascular Surgery, Duke University Medical Center, Durham, NC

Received for publication May 4, 2007; revisions received August 30, 2007; accepted for publication September 14, 2007.

* Address for reprints: James Jaggers, MD, Box 3474, DUMC, Durham, NC 27710. (Email: james.jaggers{at}duke.edu).

Objective: The evaluation of operative mortality risk for cardiac surgery in infants with low weight is limited. To determine whether low weight is a risk factor for increased mortality, we reviewed the experience within the Society of Thoracic Surgeons Congenital Heart Surgery Database of infants who have undergone surgical correction or palliation for congenital heart disease.

Methods: We analyzed mortality in 3022 infants ages 0 to 90 days weighing 1 to 2.5 kg (n = 517) and greater than 2.5 to 4 kg (n = 2505) who underwent cardiac surgery from 2002 through 2004 at 32 participating centers. Patients were grouped according to the primary procedure performed and analyzed according to their weight at the time of surgical intervention. Patients were also analyzed according to Risk Adjustment for Congenital Heart Surgery-1 and Aristotle Basic Complexity scores.

Results: Compared with infants weighing 2.5 to 4 kg, infants weighing less than 2.5 kg had a significantly higher mortality for the following operations: repair of coarctation of the aorta, total anomalous pulmonary venous connection repair, arterial switch procedure, systemic to pulmonary artery shunt, and the Norwood procedure. Lower infant weight remained strongly associated with mortality risk after stratifying the population by Risk Adjustment for Congenital Heart Surgery-1 levels 2 through 6 and Aristotle Basic Complexity levels 2 through 4.

Conclusions: Low weight at the time of surgical intervention is associated with increased mortality in patients undergoing several types of cardiovascular procedures. These data do not allow assessment of specific risks or benefits of any particular treatment strategy. However, they do support the need for prospective analysis of specific treatment strategies for these high-risk patients.

Abbreviations and Acronyms ABC = Aristotle Basic Complexity; CHD = congenital heart disease; PA/VSD = pulmonary atresia with ventricular septal defect; RACHS-1 = Risk Adjustment for Congenital Heart Surgery 1; STS = Society of Thoracic Surgeons; TGA = transposition of the great arteries




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