Abstract
Objective
The optimal timing for neonatal cardiac surgery is a potentially modifiable factor
that may affect outcomes. We studied the relationship between age at surgery (AAS)
and outcomes across multiple hospitals, focusing on neonatal operations where timing
appears is not emergency.
Methods
We studied neonates ≥37 weeks' gestation and ≥2.5 kg admitted to a treating hospital
on or before day of life 2 undergoing selected index cardiac operations. The impact
of AAS on outcomes was evaluated across the entire cohort and a standard risk subgroup
(ie, free of preoperative mechanical ventilation, mechanical circulatory support,
or other organ failure). Outcomes included mortality, major morbidity (ie, cardiac
arrest, mechanical circulatory support, unplanned cardiac reintervention, or neurologic
complication), and postoperative cardiac intensive care unit and hospital length of
stay. Post hoc analyses focused on operations undertaken between day of life 2 and
7.
Results
We studied 2536 neonates from 47 hospitals. AAS from day of life 2 through 7 was not
associated with risk adjusted mortality or major morbidity among the entire cohort
and the standard risk subgroup. Older AAS, although associated with modest increases
in postoperative cardiac intensive care unit and hospital length of stay in the entire
cohort, was not associated with hospital length of stay in the standard risk subgroup.
Conclusions
Among select nonemergency neonatal cardiac operations, AAS between day of life 2 and
7 was not found to be associated with risk adjusted mortality or major morbidity.
Although delays in surgical timing may modestly increase preoperative resource use,
studies of AAS and outcomes not evident at the time of discharge are needed.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
AAS (age at surgery), ASO (arterial switch operation), ASO + VSD (arterial switch operation with ventricular septal defect closure), CICU (cardiac intensive care unit), LOS (length of stay), PC4 (Pediatric Cardiac Critical Care Consortium), S1P (stage 1 Norwood palliation), STS (Society of Thoracic Surgeons), TA (truncus arteriosus)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 01, 2022
Accepted:
May 10,
2022
Received in revised form:
April 22,
2022
Received:
November 23,
2021
Footnotes
This study was supported in part by funding from the University of Michigan Congenital Heart Center, CHAMPS for Mott, and the Michigan Institute for Clinical and Health Research (National Institutes of Health/National Center for Advancing Translational Sciences grant No. UL1TR002240).
Identification
Copyright
© 2022 by The American Association for Thoracic Surgery
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Access this article on ScienceDirectLinked Article
- Commentary: Timing of neonatal heart surgery: One less target in the quest for perfectionThe Journal of Thoracic and Cardiovascular SurgeryVol. 165Issue 4
- PreviewThe manuscript by Smith and colleagues1 uses the Pediatric Cardiac Critical Care Consortium (PC4) database to explore the relationship between outcomes of 4 neonatal heart operations (arterial switch operation [ASO]; arterial switch operation with ventricular septal defect closure, [ASO + VSD]; stage 1 Norwood palliation; and truncus arteriosus [TA]) and timing of surgery within days 2 to 7 of life. This has been a vexing topic in congenital heart surgery, with various single-institution studies producing conflicting results.
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