Immediate postpartum cardiac surgery for critical congenital heart disease: cardiopulmonary bypass management and early outcomes in 21 neonates

Objective: To summarize our center's experience with cardiopulmonary bypass (CPB) management in 21 neonates with critical congenital heart disease (CCHD) who underwent immediate postpartum cardiac surgery, and to report their early clinical outcomes. Methods: This retrospective case series included 21 neonates with CCHD who underwent immediate postpartum cardiac surgery at Beijing Anzhen Hospital between December 2022 and July 2024. The timeliness of surgery, key CPB management parameters, and perioperative clinical outcomes were analyzed. Results: The median time from delivery to arrival in the cardiac operating room was 8.0 min (IQR: 6.0-19.5 min). The mean CPB duration was 178.4 ± 12.3 min, with a median aortic cross-clamping time of 138.0 min (IQR: 76.0-158.5 min). The lowest mean nasopharyngeal temperature during CPB was 30.2 ± 0.2 °C. The volume of red blood cells transfused during CPB was 142.4 ± 2.2 mL, and the mean hematocrit level after modified ultrafiltration was 38.1%±1.1%. All 21 neonates were successfully weaned from CPB without delayed chest closure. The overall survival rate was 95% (20/21), with a median hospital stay of 21.0 days (IQR: 13.5-28.0 days) and median ICU stay of 10.0 days (IQR: 7.5-15.5 days). Major adverse events occurred in three patients (14.3%): two who recovered after reoperation and one who died from multiorgan failure secondary to low cardiac output caused by obstructive hypertrophic cardiomyopathy. Conclusion: With standardized and refined CPB management strategies, immediate postpartum cardiac surgery is technically feasible in neonates with CCHD and can achieve acceptable early clinical outcomes. This approach may serve as an alternative strategy for centers lacking rapid interventional capabilities.