Abstract 15005: Neonatal Cardiac Surgery: Impact of Timing of Surgical Intervention
Background: The optimal timing for neonatal cardiac surgery is unknown. Advocates of early intervention cite potential benefits of limiting exposure to cyanosis and inadequate oxygen delivery, and reduction in resource utilization. We aimed to determine the relationship between age at surgery and perioperative outcomes, hypothesizing that earlier intervention would associate with lower morbidity and mortality.
Methods: A retrospective review was performed on neonates undergoing surgery for d-transposition of the great arteries (TGA), hypoplastic left heart syndrome (HLHS) or obstructed pulmonary blood flow (OPBF) from 1/1/2005-12/31/2010. Subjects with a clinical indication for delay of surgery (e.g. sepsis, intracranial hemorrhage) or prematurity (<37 weeks gestation) were excluded. Age at surgery was evaluated as both a continuous and a categorical variable. The primary outcome was a composite endpoint of in-hospital mortality or prolonged ICU length of stay. Associations between age and outcome were analyzed by procedure subgroup using the Wilcoxon rank sum, Chi-square or Fisher’s exact test as appropriate.
Results: Of 344 total subjects, 286 (77 TGA, 124 HLHS, 85 OBPF) met inclusion criteria. In each group, age at surgery was not associated with the primary composite endpoint. Patients with OPBF who died postoperatively had a median age at surgery of 3 days vs. 6 for those who survived (p = 0.04). There was a similar pattern in patients with TGA (median age 4.5 days vs. 7), but this was not statistically significant (p=0.09). Younger age at surgery was not associated with reduced duration of vasoactive support, mechanical ventilation, or ICU length of stay in any group. HLHS subjects with an age at surgery in the upper quartile (≥8 days) were significantly less likely to require prolonged ventilation (p=0.03).
Conclusion: Contrary to our hypothesis, younger age at intervention in the neonatal period is not associated with reduced morbidity and mortality for patients with TGA, HLHS and OPBF. In each procedural group, older age at surgery appeared protective. Future studies are necessary to confirm and explore the reasons for these findings, as they have implications for resource utilization in organizing pediatric cardiac surgical programs.
- © 2012 by American Heart Association, Inc.