SHA24/039004

Akhter Mehmood, Sameh R Ismail, Mohamed S Kabbani, Riyadh M Abu-sulaiman, Hani K Najm.

King AbdulAziz Cardiac Center, King AbdulAziz Medical city.

National Guard Health Affair, Riyadh, Saudi Arabia

1

Low body weight (LBW) are major challenges for post cardiac surgery care 

Incidence of LBW is approximately 8–23% of live born infants with CHD, 



It varies with specific congenital heart defect.

Levy RJ,.

Am J Dis Child 1978 2

ď ą LBW infants who undergo cardiac surgery have significant mortality and morbidity.

ď ą LBW infants have

higher mortality rates for

different kinds of cardiac procedures as compared to infants of normal birth weight in same

risk

category of cardiac surgery.

Curzon CL et al. J Thorac cardiovasc Surg, 2008 3



Prolonged medical therapy to achieve further

weight gain in LBW(WT<2.5 KG) increase the morbidity and mortality as compared to early intervention. 

Chang AC et al, J pediatr 1994

Imposed

delays in intervention increase the

morbidity in neonates (<2.0 kg) with congenital heart defects as compared with early intervention Hickey

E et al, J Thorac Cardiovasc Surg 2012 4

We conducted this study to compare: postoperative course and outcome of infants weighing 2.2 Kg or less with matching group of infants with normal body weight who underwent similar cardiac surgery.

5

ď ąWe

reviewed retrospectively all infants below 2.2

kg who underwent cardiac operation at our institution from January 2001 to March 2011.

ď ąCases

with LBW (group A) were compared with

matching group (Group B) of normal body weight

6

Methods 

Both groups have similar cardiac surgery and matching surgical risk category.



We compared demographic, ICU parameters, complications and short-term outcome of both groups.



We excluded all cases of PDA ligation

7

Results: Demographic Data

8

Comparison between weight and age in Groups A and B P < 0.01 for WT

9

Different types of cardiac surgery in Groups A and B Type of

Low wt

Cardiac

group A (37)

Surgery Coarctation of

20

aorta ASO MBTS NORWOOD stage-1 PAB VSD Repair

control group B (39) 18

4 6 1

1.00 6 4

1 2 3

(P) value

0.74 0.73 1.00

3

1.00

5

0.71 1.00

10

Variable Peri-operative data Surgical Risk category Bypass Time (min) Cross clamp time (min) Average Inotrops duration (hrs) Maximum no of inotrops Average ventilation time (hrs) Average ICU length of stay (days) Average hospital length of stay (days)

Group (A)

Group (B)

37 Low weight

39 Control

group

group

2.5 ±1

2.5 ± 0.81

0.85

147.14 ±119.03

93.25 ± 45.15

0.01

50.3 ± 46.2

39 ± 22.3

0.18

160.3 ± 228.6

64.2 ± 63.6

0.01

P Value

0.08

2.2 ± 1.2

1.7 ±1.2

231.4 ± 280.5

91.9 ± 105.2

0.004

14 ± 13.8

7.3 ± 6.4

0.008 11

21.5 ± 16

17.3 ± 15.3

0.24

Post â&#x20AC;&#x201C;operative complications

Group (A)

Group (B)

P Value

Stridor

2/37 (5.4%)

1/39 (3%)

1.00

Low cardiac output

7/37 (19%)

6/39 (15%)

0.77

Diaphragmatic paralysis

1/37 (3%)

0/39 (0%)

0.49

9/37 (24%)

5/39 (13%)

0.24

(with temporary dialysis)

8/37 (22%)

4/39 (10%)

0.22

New onset of seizure

4/37 (11%)

1/39 (2.5%)

0.19

pneumothorax

3/37 (8%)

9/39 (23%)

0.11

Pleural effusion

2/37 (5%)

1/39 (2.5%)

0.61

7/37 (19%)

4/39 (10%)

0.34

18/37 (49%)

8/39 (21%)

0.015

3/37 (8%)

0/39 (0%)

0.11

Septicemia Acute kidney injury

Arrhythmias Number of re-intubations Chylothorax

There was no statistical difference in demographic data between both groups except for WT. 

Patients in group A had statistically significant difference from

group B in term of:  Long Bypass time (p =0.01),  Long duration of inotrops (p=0.01),  Prolong duration of mechanical ventilation (p=0.004)  Number of re-intubations (p = 0.015),  PCICU length of stay (p =0.007)  Mortality-5/37 (13.5%) in group A and 0% in group B,  (p value 0.02) 13

Discussion Review studies

Man Seo et alPediatr Cardiol (2011)

Centre conducted study

Number patients

Alive

Died

Mortality

San Francisco, CA, USA

122

99

23

22.5%

32 centers in world

517

445

72

13.9%

Mount Sinai ; 11Medical Center, New York, N.Y.

24

19

5

17%

Curzon et al J Cardiovasc and Thoracic Surg2008 Rossi et al.

J Thorac Cardiovasc Surg- 1998

14

Discussion Review studies

G.Oppidio J,ped cardiology 2004 T,Bove J.Cardiothoracic surgery 2004 E. Lechner E J cardiothoracic surgery 2009

Centre conducted study

Number patients

alive

Died

Mortality

60

51

9

15%

Gent U, hospital Belgium

49

43

6

18%.

General hospital Linz,Austeria

46

37

9

13%

Orsola. M hospital Italy

15

Patients with LBW below 2.2 Kg can go for cardiac surgery with overall satisfactory result but with acceptable increase risk of ICU morbidity and mortality.

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