Predictive role of intraoperative variables in neonatal cardiac surgery outcomes

Abstract

Aim: This study investigates the association of intraoperative variables, including anesthesia and cardiopulmonary bypass (CPB) durations, delta CO2 (Delta CO2), and lactate levels, with postoperative morbidity and mortality in neonates undergoing complex congenital cardiac surgery. Materials and Methods: A retrospective analysis was conducted on 42 neonates who underwent surgery in a single center. Data on demographic characteristics, genetic anomalies, anesthesia and CPB durations, and blood gas parameters (Delta CO2 and lactate levels at entry [T0], post-CPB [T1], and intensive care unit admission [T2]) were collected. Associations between these variables and major adverse events (MAEs) or mortality were statistically analyzed. Results: A total of 42 neonatal patients were included in the study. The median age of the patients was calculated as 0.4 +/- 0.3 months. The mean weight of the sample was 3.3 +/- 0.6 kg, and the median total anesthesia and CPB durations were 378.45 +/- 103.67 and 116.86 +/- 55.03 minutes, respectively. Delta CO2 levels at T0 were significantly associated with MAEs (p < 0.05), while elevated Delta CO2 at T0 and T1 was observed in patients who died. Total anesthesia duration was a significant predictor of both MAEs and mortality (p = 0.014). Lactate levels, however, showed no significant correlation with either MAEs or mortality at any time point. Discussion: Prolonged anesthesia and CPB durations, along with elevated Delta CO2 levels, are key predictors of adverse outcomes in neonates undergoing cardiac surgery. Delta CO2 may serve as an additional marker for early postoperative risk stratification. Larger prospective studies are warranted to confirm these findings and improve clinical management strategies.