Preterm Infants With Congenital Heart Disease and Bronchopulmonary Dysplasia: Postoperative Course and Outcome After Cardiac Surgery

• Published in: Pediatrics (Evanston) 2005-08, Vol.116 (2), p.423-430
• Main Authors: McMahon, Colin J, Penny, Daniel J, Nelson, David P, Ades, Anne M, Al Maskary, Salim, Speer, Michael, Katkin, Julie, McKenzie, E. Dean, Fraser, Charles D., Jr, MD, Chang, Anthony C
• Format: Article
• Language: English
• Subjects: Babies; Biological and medical sciences; Birth weight; Bronchopulmonary Dysplasia - complications; Bronchopulmonary Dysplasia - mortality; Cardiac Surgical Procedures - mortality; Cardiovascular disease; Care and treatment; Congenital heart defects; Congenital heart disease; General aspects; Health aspects; Heart; Heart Defects, Congenital - complications; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Heart surgery; Humans; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Infants (Premature); Medical disorders; Medical sciences; Palliative Care; Patient outcomes; Pediatrics; Pneumology; Postoperative Care; Postoperative Complications; Premature infants; Preoperative Care; Reoperation; Respiration, Artificial; Respiratory system : syndromes and miscellaneous diseases; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Treatment Outcome
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2004-2168

Success in treatment of premature infants has resulted in increased numbers of neonates who have bronchopulmonary dysplasia (BPD) and require surgical palliation or repair of congenital heart disease (CHD). We sought to investigate the impact of BPD on children with CHD after heart surgery. This was a retrospective, multicenter study of patients who had BPD, defined as being oxygen dependent at 28 days of age with radiographic changes, and CHD and had cardiac surgery (excluding arterial duct ligation) between January 1991 and January 2002. Forty-three infants underwent a total of 52 cardiac operations. The median gestational age at birth was 28 weeks (range: 23-35 weeks), birth weight was 1460 g (range: 431-2500 g), and age at surgery was 2.7 months (range: 1.0-11.6 months). Diagnoses included left-to-right shunts (n = 15), conotruncal abnormalities (n = 13), arch obstruction (n = 6), univentricular hearts (n = 4), semilunar valve obstruction (n = 3), Shone syndrome (n = 1), and cor triatriatum (n = 1). Thirty-day survival was 84% with 6 early and 6 late postoperative deaths. Survival to hospital discharge was 68%. There was 50% mortality for patients with univentricular hearts and severe BPD. The median duration of preoperative ventilation was 76 days (range: 2-244 days) and of postoperative ventilation was 15 days (range: 1-141 days). The median duration of cardiac ICU stay was 7.5 days (range: 1-30 days) and of hospital stay was 115 days (range: 35-475 days). Current pulmonary status includes on room air (n = 14), O2 at home (n = 4), and ventilated at home (n = 4) or in hospital (n = 4), and 5 patients were lost to follow-up. BPD has significant implications for children who have CHD and undergo cardiac surgery, leading to prolonged ICU and hospital stays, although most survivors are not O2 dependent. Postoperative mortality was highest among patients with univentricular hearts and severe BPD. Optimal timing of surgery and strategies to improve outcome remains to be delineated.