Analysis Of Surgical Risk Factors In Children With Congenital Heart Disease Less Than 5kg

Objective:To analyze the surgical risk factors in children with congenital heart disease whose body weight was 5kg or less.Methods:A retrospective analysis was made on the clinical data of 556 cases of children with congenital heart disease whose weight was less than 5kg from January 2012 to December 2016.The clinical data include gender,age,weight,nutritional status,the types of cardiac abnormalities,preoperative mechanical ventilation,preoperative ICU hospitalization,Surgical method(radical operation/palliative operation),RACHS-1,CPB(cardiopulmonary bypass)time,ACC(Aortic cross clamp)time,complications and so on.Results: Among the 566 children,503(90.48%)of them had a successful operation and discharged alive,53 children died after operation,with a mortality rate of 9.53%.In the survival group,the average age was 3.44±1.97 months,the body weight was 4.20±0.57 kg,the CPB time was 109.17±48.26 minutes,the ACC time was 50.32±25.57 minutes,the postoperative mechanical ventilation time was 89.02±100.19 minutes,and the postoperative length of stay in the ICU was 146.49±144.14 minutes.In the death group,the average age was 2.15±1.67 months,the average weight was 3.81±0.71 kg,the CPB time was 244.94±117.46 minutes,the ACC time was 96.17±50.03 minutes,the postoperative mechanical ventilation time was 47.03±104.48 minutes,the postoperative length of stay in the ICU was 73.58± 199.95 minutes,and the postoperative time to death was 2.23±6.79 days.42(17.14%)children with complex congenital heart disease died,while 11(3.54%)children with simple congenital heart disease died.18 children with RACHS-1?2 died(4.96%),and 35 children with RACHS-1?3 died(18.13%).There were 209 cases of emergency/subemergency surgery,and 41 cases(19.62%)died.A total of 126 cases were treated by emergency/ subemergency surgery for life-threatening conditions caused by delayed treatment.The major postoperative complication was low cardiac output syndrome(25.18%).The multivariable analysis identified preoperative mechanical ventilation history,palliative surgery,RACHS-1 grade ?3,CPB time,postoperative low cardiac output syndrome were the independent risk factors for surgical death in children with congenital heart disease less than 5 kg.For the postoperative recovery of the children,the postoperative mechanical ventilation time and postoperative ICU hospitalization time of the children with simple CHD treated by emergency/subemergency surgery were higher than that of the patients treated with selective surgery(P<0.05).And the incidence of postoperative complications,postoperative ICU hospitalization time and postoperative mortality of children with complex preoccupation treated by emergency/subemergency surgery were higher than those treated by selective surgery(P < 0.05).Compared to children with simple CHD older than 1 month,the incidence of postoperative complications was higher in children who were younger than 1 month(P < 0.05).And there was no statistically significant difference between different age groups and indicators in children with complex CHD(P > 0.05).Conclusion:1.Surgical treatment of low-weight congenital heart disease(CHD)of 5 kg or less is safe and effective.However,the overall mortality rate was relatively high,which required further improvement of the perioperative treatment,cardiopulmonary bypass,anesthesia,surgical techniques.2.The multivariable analysis identified preoperative mechanical ventilation history,palliative surgery,RACHS-1 grade ?3,CPB time,postoperative low cardiac output syndrome were the independent risk factors for surgical death in children with congenital heart disease less than 5 kg.3.Selecting the appropriate timing of operation is important.Patients with surgery indications should be operated as soon as possible to prevent some patients from being in critical condition because of the delay of treatment and reduce the incidence of emergency/subemergency surgery.