Congenital cardiac surgery in newborns – current outcome

Objective: In recent years congenital cardiac surgery is being performed more frequently in newborns aiming at early compete correction. Aim of this study was to evaluate the current outcome in relation to the individual diagnoses and risk profiles.

Methods: Since 1998 a total of 2050 patients operated for congenital cardiac defects were prospectively documented in an online database. Off those 416 patients were newborns. 153 were female, mean age was 9.9±6.5 days, body weight 3.1±0.7kg. Aristotle basic score was 9±3 and complexity score 3.1±0.9. The complexity score was one in 28 (6.7%), two in 81 (19.5%), three in 122 (29.3%) and four in 185 (44.5%) of the patients, respectively. Mean follow-up is 3.5±2.2 years.

Results: 22 patients died in-hospital (5.3%). 19/72 patients with FSV/HLHS palliation (26.4%) and 3/344 with biventricular repair (0.9%) died. During follow-up 8 patients died late (2%), six after stage-I Norwood palliation. According to the complexity score 9 patients died postoperatively with a score of four (4.9%), 5 with a score of three (4.2%) and 8 with a score of two (9.9%) died. In the latter group seven patients had received an A-P shunt in complex underlying pathologies.

Conclusion: Congenital cardiac surgery can be safely performed in the newborn age group. In the biventricular repair group there is no risk factor regarding the age, weight and complexity of the procedure. Functional single ventricle as well as primary shunt palliation for complex pathologies are associated with an increased risk. This risk is not well reflected by the Aristotle score.