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
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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
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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.
16