Congenital: Perioperative Management| Volume 165, ISSUE 4, P1528-1538.e7, April 2023

Age at surgery and outcomes following neonatal cardiac surgery: An analysis from the Pediatric Cardiac Critical Care Consortium



      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.


      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.


      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.


      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

      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)
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      Linked Article

      • Commentary: Timing of neonatal heart surgery: One less target in the quest for perfection
        The Journal of Thoracic and Cardiovascular SurgeryVol. 165Issue 4
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          The 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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