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Alternative strategies in newborns and infants with major co-morbidities to improve congenital heart surgery outcomes at an emerging programme*

  • Jannika Dodge-Khatami (a1), Ali Dodge-Khatami (a2), Jarrod D. Knudson (a3) (a4), Samantha R. Seals (a5), Avichal Aggarwal (a3), Mary B. Taylor (a3) (a4) and Jorge D. Salazar (a2)...



Debilitating patient-related non-cardiac co-morbidity cumulatively increases risk for congenital heart surgery. At our emerging programme, flexible surgical strategies were used in high-risk neonates and infants generally considered in-operable, in an attempt to make them surgical candidates and achieve excellent outcomes.

Materials and methods

Between April, 2010 and November, 2013, all referred neonates (142) and infants (300) (average scores: RACHS 2.8 and STAT 3.0) underwent 442 primary cardiac operations: patients with bi-ventricular lesions underwent standard (n=294) or alternative (n=19) repair/staging strategies, such as pulmonary artery banding(s), ductal stenting, right outflow patching, etc. Patients with uni-ventricular hearts followed standard (n=96) or alternative hybrid (n=34) staging. The impact of major pre-operative risk factors (37%), standard or alternative surgical strategy, prematurity (50%), gestational age, low birth weight, genetic syndromes (23%), and major non-cardiac co-morbidity requiring same admission surgery (27%) was analysed on the need for extracorporeal membrane oxygenation, mortality, length of intubation, as well as ICU and hospital length of stays.


The need for extracorporeal membrane oxygenation (8%) and hospital survival (94%) varied significantly between surgical strategy groups (p=0.0083 and 0.028, respectively). In high-risk patients, alternative bi- and uni-ventricular strategies minimised mortality, but were associated with prolonged intubation and ICU stay. Major pre-operative risk factors and lower weight at surgery significantly correlated with prolonged intubation, hospital length of stay, and mortality.


In our emerging programme, flexible surgical strategies were offered to 53/442 high-risk neonates and infants with complex CHDs and significant non-cardiac co-morbidity, in order to buffer risk and achieve patient survival, although at the cost of increased resource utilisation.


Corresponding author

Correspondence to: Ali Dodge-Khatami, MD, PhD, Chief, Professor of Surgery, Pediatric and Congenital Heart Surgery, Children’s Heart Center, University of Mississippi Medical Center, 2500 North State Street, Room S345, Jackson MS 39216, United States of America. Tel: +601 984 4693; Fax: +601 984 5872; E-mail:


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Meeting Presentation: some contents of the abstract were presented at the 10th International Conference of the Pediatric Cardiac Intensive Care Society, Miami, Florida, USA, 11–14 December, 2014.



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