Abstract
Objectives
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.
Methods
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.
Results
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.
Conclusions
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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Graphical Abstract
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 28, 2022
Accepted:
June 20,
2022
Received in revised form:
May 26,
2022
Received:
February 27,
2022
Footnotes
This study was approved by the Internal Review Board at Columbia University Irving Medical Center along with a waiver of informed consent (IRB# and date of approval: AAAQ9880; 11/07/2016).
Identification
Copyright
© 2022 by The American Association for Thoracic Surgery
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Access this article on ScienceDirectLinked Article
- Commentary: Neonatal cardiac care units: The next step in specialization and regionalizationThe Journal of Thoracic and Cardiovascular SurgeryVol. 165Issue 6
- PreviewThe 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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