Congenital: Perioperative Management| Volume 165, ISSUE 6, P2204-2211.e4, June 2023

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Outcomes after neonatal cardiac surgery: The impact of a dedicated neonatal cardiac program



      Prematurity is a risk factor for in-hospital mortality after cardiac surgery. The structure of intensive care unit models designed to deliver optimal care to neonates including those born preterm with critical congenital heart disease is unknown. The objective of this study was to evaluate in-hospital outcomes after cardiac surgery across gestational ages in an institution with a dedicated neonatal cardiac program.


      This study is a single-center, retrospective review of infants who underwent cardiac surgical interventions from our dedicated neonatal cardiac intensive care program between 2006 and 2017. We evaluated in-hospital mortality and morbidity rates across all gestational ages.


      A total of 1238 subjects met inclusion criteria over a 11-year period. Overall in-hospital mortality after cardiac surgery was 6.1%. The mortality rate in very preterm infants (n = 68; <34 weeks' gestation at birth) was 17.6% (odds ratio, 3.52 [1.4-8.53]), versus 4.3% in full-term (n = 563; 39-40 weeks) referent/control infants. Very preterm infants with isolated congenital heart disease (without evidence of other affected organ systems) experienced a mortality rate of 10.5% after cardiac surgery. Neither the late preterm (34-36 6/7 weeks) nor the early term (37-38 6/7) groups had significantly increased odds of mortality compared with full-term infants. Seventy-eight percent of very preterm infants incurred a preoperative or postoperative complication (odds ratio, 4.78 [2.61-8.97]) compared with 35% of full-term infants.


      In this study of a single center with a dedicated neonatal cardiac program, we report some of the lowest mortality and morbidity rates after cardiac surgery in preterm infants in the recent era. The potential survival advantage of this model is most striking for very preterm infants born with isolated congenital heart disease.

      Video Abstract

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      Key Words

      Abbreviations and Acronyms:

      cCHD (critical congenital heart disease), CHD (congenital heart disease), CI (confidence interval), CICU (cardiac intensive care unit), FT (full-term), GA (gestational age), HLHS (hypoplastic left heart syndrome), LOS (length of stay), NICU (neonatal intensive care unit), OR (odds ratio), PICU (pediatric intensive care unit), PT (preterm), STAT (Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery), VPT (very preterm)
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      Linked Article

      • Commentary: Neonatal cardiac care units: The next step in specialization and regionalization
        The Journal of Thoracic and Cardiovascular SurgeryVol. 165Issue 6
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          The congenital heart center program from Columbia University in New York has reported the outcomes of a novel dedicated neonatal cardiac care unit.2 This is one of the first units of its kind in the United States. The review covers a 10-year period from 2006 through 2017. During that time, the center had a distinct cardiac neonatal intensive care unit (ICU), which was a 17-bed subunit physically and functionally distinct in team structure and practices. This unit was separate from the pediatric cardiac ICU and the general neonatal ICU.
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