Skip to main content
    • Aa
    • Aa

Morbidity and mortality after surgery for congenital cardiac disease in the infant born with low weight

  • Anne M. Ades (a1), Troy E. Dominguez (a2), Susan C. Nicolson (a2), James W. Gaynor (a3), Thomas L. Spray (a3), Gil Wernovsky (a2) (a4) and Sarah Tabbutt (a2) (a4)...

Low weight at birth is a risk factor for increased mortality in infants undergoing surgery for congenitally malformed hearts. There has been a trend towards performing surgery in patients early, and for amenable lesions, in a single stage rather than following initial palliative procedures. Our goal was to report on the current incidences of morbidities and mortality in infants born with low weight and undergoing surgery for congenital cardiac disease.


We made a retrospective review of the data from patients meeting our criterions for entry from July, 2000, through July, 2004. The criterions for inclusion were weight at birth less than or equal to 2500 grams, and congenital cardiac malformations requiring surgery during the initial hospitalization. A criterion for exclusion was isolated persistent patency of the arterial duct. We assessed preoperative, intraoperative, and postoperative variables.


We found a total of 105 patients meeting the criterions for inclusion. The median weight at birth was 2130 grams, and median gestational age was 36 weeks. The most common morbidity identified was infections of the blood stream. Infections, and chronic lung disease, were associated with increased length of stay. Survival overall was 76%. Patients with hypoplastic left heart syndrome, or a variant thereof, had the lowest survival, of 62%. The needs for cardiopulmonary resuscitation, or extracorporeal membrane oxygenation, post-operatively were the only factors identified as independent risk factors for mortality.


Patients undergoing surgery during infancy for congenital cardiac disease who are born with low weight have a higher mortality and morbidity than those born with normal weight.

Corresponding author
Correspondence to: Anne M. Ades MD, Division of Neonatology, 2nd Floor, Main Building, The Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104. Tel: 215-590-1653; Fax: 215-590-3081; E-mail:
Hide All
1.Rosenthal GL, Wilson PD, Pemutt T, Boughman JA, Ferencz C. Birth weight and cardiovascular malformations: a population based study. Am J Epidemiol 1991; 133: 12731281.
2.Levy RJ, Rosenthal A, Fyler DC, Nadas AS. Birthweight of infants with congenital cardiac disease. Am J Dis Child 1978; 132: 249254.
3.Kramer HH, Trampisch HJ, Rammos S, Giese A. Birthweight of children with congenital cardiac disease. Eur J Pediatrics 1990; 149: 752757.
4.Pawade A, Waterson K, Laussen P, Karl TR, Mee RBB. Cardiopulmonary bypass in neonates weighing less than 2.5 kg: analysis of the risk factors for early and late mortality. J Card Surg 1993; 8: 18.
5.Chang AC, Hanley FH, Lock JE, Castaneda AR, Wessel DL. Management and outcome of low birth weight neonates with congenital cardiac disease. J Pediatr 1994; 124: 461466.
6.Reddy VM, McElhinney DB, Sagrado T, Parry AJ, Teitel DF, Hanley FL. Results of 102 cases of complete repair of congenital heart defects in patients weighing 700 to 2500 grams. J Thorac Cardiovasc Surg 1999; 117: 324331.
7.Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr 1967; 71: 159163.
8.Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Ped Clinic of N Am 1986; 33: 179201.
9.Jobe AH, Bancalari E. Bronchopulmonary dysplasia: NICHD/NHLBI/ORD workshop summary. Am J Respir Crit Care Med 2001; 162: 17231729.
10.Clancy RR, McGaurn SA, Wernovsky G, et al. Preoperative risk-of-death prediction model in heart surgery with deep hypothermic circulatory arrest in the neonate. J Thorac Cardiovasc Surg 2000; 119: 347357.
11.Numa A, Butt W, Mee RBB. Outcome of infants with birthweight 2000 g or less who undergo major cardiac surgery. J Paediatr Child Health 1992; 28: 318320.
12.Dees E, Lin H, Cotton RB, Graham TP, Dodd DA. Outcome of preterm infants with congenital cardiac disease. J Pediatr 2000; 137: 653659.
13.Reddy VM, Hanley FL. Cardiac surgery in very low birth weight infants. Semin Pediatric Surg 2000; 9: 9195.
14.Oppido G, Napoleone CP, Formigari R, et al. Outcome of cardiac surgery in low birth weight premature infants. Eur J Cardio-thorac Surg 2004; 24: 4453.
15.Rossi AF, Seiden HS, Sadeghi AM, et al. The outcome of cardiac operations in infants weighing two kilograms or less. J Thorac Cardiovasc Surg 1998; 116: 2835.
16.Simchen MJ, Beiner ME, Liviathan NS, et al. Neonatal outcome in growth-restricted versus appropriately grown preterm infants. Am J Perinatol 2000; 17: 187192.
17.Bardin C, Zelkowitz P, Papageorgiou. Outcomes of small-for-gestational age and appropriate-for-gestational age infants born before 27 weeks of gestation. Pediatrics 1997; 100: e4.
18.Regev RH, Lusky A, Dolfin T, Litmanovitz I, Arnon S, Reichman B. Excess mortality and morbidity among small-for-gestational-age premature infants: A population based study. J Pediatr 2003; 143: 186191.
19.Aucott SW, Donohue PK, Northington FJ. Increased morbidity in severe early intrauterine growth restriction. J Perinatol 2004; 24: 435440.
20.Abrishamchian R, Kanhai D, Zwets E, Nie L, Cardarelli M. Low birth weight or diagnosis, which is higher risk?-a meta-analysis of observational studies. Eur J Cardio-thorac Surg 2006; 30: 700705.
21.Pizarro C, Davis DA, Galantowicz ME, Munro H, Gidding SS, Norwood WI. Stage I palliation for hypoplastic left heart syndrome in low birth weight neonates: can we justify it? Eur J Cardio-thorac Surg 2002; 21: 716720.
22.Weinstein S, Gaynor JW, Bridges ND, et al. Early survival of infants weighing 2.5 kilograms or less undergoing first-stage reconstruction for hypoplastic left heart syndrome. Circulation 1999; 100 (Suppl II): II-167II-170.
23.Tabbutt S, Dominguez TE, Ravishankar C, et al. Outcomes after the stage I reconstruction comparing the right ventricular to pulmonary artery conduit with the modified Blalock Taussig shunt. Ann Thorac Surg 2005; 80: 15821590.
24.Beyens T, Biarent D, Bouton JM, et al. Cardiac surgery with extracorporeal circulation in 23 infants weighing 2500 g or less: Short and intermediate term outcome. Eur J Cardio-thorac Surg 1998; 14: 165172.
25.Fanaroff A, Stoll B, Wright L, et al. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 2007; 196: 147e1147e8.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 6
Total number of PDF views: 32 *
Loading metrics...

Abstract views

Total abstract views: 287 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd October 2017. This data will be updated every 24 hours.