Critical congenital heart disease in extreme prematurity: Surgical outcomes from a specialized neonatal cardiac intensive care unit

<h2>Abstract</h2><h3>Objectives</h3> Prematurity is a risk factor for in-hospital mortality after cardiac surgery. Among preterm infants, very preterm (VPT) infants are at the greatest risk of mortality. We evaluated risk factors for in-hospital mortality in VPT infants born at <34 weeks of gestational age with critical congenital heart disease (CHD) who underwent cardiac surgery at our institution. <h3>Methods</h3> This study is a single-center, retrospective review of VPT infants who underwent cardiac surgical intervention from our dedicated neonatal cardiac care program (Columbia model) between 2006 and 2021. The primary outcome was in-hospital mortality. <h3>Results</h3> A total of 109 subjects met the inclusion criteria. Overall, the in-hospital mortality rate for VPT infants was 16.5% overall, 11% in those with isolated critical CHD, and 34% in those with an identified genetic diagnosis (<i>P</i> = .028). Independent risk factors for mortality included 5-minute Apgar score, cardiopulmonary bypass time, and total number of postoperative complications. Mortality risk also improved over time between 2006 and 2021. <h3>Conclusions</h3> The Columbia model with its dedicated neonatal cardiac program shows a lower mortality rate in VPT infants compared to the literature. Initiatives that reduce the burden of modifiable risk factors, such as the number of complications, may improve survival in this population. <h3>Video Abstract</h3>