Neonatal Cardiac Surgery

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What is Neonatal Cardiac Surgery?

Neonatal cardiac surgery is the surgical treatment of congenital heart defects (CHD) in newborn babies. CHDs are the most common type of birth defect, affecting about 1 in 100 babies born in the United States. They can range from mild to severe, and some can be fatal if not treated. 

Neonatal cardiac surgery may be performed to repair a variety of congenital heart defects, including hypoplastic left heart syndrome, transposition of the great arteries and many more.

The goals of neonatal cardiac surgery are to create a durable circulation, improve heart function, correct the baby's blood flow to improve oxygen levels and relieve symptoms such as shortness of breath and difficulty feeding and growing.

Neonatal cardiac surgeries are complex. Lurie Children’s has a nationally-ranked Heart Center team that has achieved highly successful outcomes for many years. With advances in surgical techniques and technology, many children are now surviving the neonatal period and thriving as they grow into adulthood.

Despite the challenges, neonatal cardiac surgery is a life-saving procedure that often greatly improves the outlook for babies with CHD.

Learn more about neonatal cardiac surgery, our program and what to expect below.

Conditions Requiring Neonatal Cardiac Surgery

Some of the most common CHDs that require neonatal cardiac surgery include:

  • Transposition of the great arteries (TGA): TGA is a condition in which the main arteries that carry blood from the heart to the lungs and body are incorrectly connected. Babies with TGA usually need surgery within the first few days of life, with an arterial ‘switch’ operation that corrects the problem.

  • Tetralogy of Fallot (TOF): Tetralogy of Fallot usually involves limitation of blood flow to the lungs leading to low oxygen levels in the blood. Not all patients with Tetralogy of Fallot will require surgery in the first month of life. Some may benefit from a cardiac catheter-based intervention to increase blood flow to the lungs allowing the team to push back the operation. Others will be born with a safe amount of blood flow to the lungs and can have their operation planned electively within the first six months of life.

  • Ventricular septal defect (VSD): VSD is a hole in the wall between the two lower chambers of the heart resulting in too much blood flow going to the lungs. Most babies who require VSD surgery can be medically managed for a period of time before surgery at a few months of age, however some with associated problems may benefit from neonatal cardiac surgery.

  • Coarctation of the aorta: Coarctation is a narrowing of the aorta, which is the main artery that carries oxygen-rich blood from the heart to the body. Babies with important aortic coarctation usually need surgery within the first few weeks of life.

  • Aortic valve stenosis: Aortic valve stenosis is a narrowing of the aortic valve, which regulates blood flow from the left ventricle to the aorta. Aortic valve stenosis can cause problems with heart function and growth. Babies with severe AVS may need surgery within the first few months of life, sometimes after an earlier cardiac catheter procedure.

  • Truncus arteriosus: Truncus arteriosus is a rare CHD in which the two main arteries that come out of the heart do not completely divide, resulting in a single arterial trunk. Babies with truncus arteriosus require a neonatal surgery to divide this arterial trunk into two separate arteries and close the ventricular septal defect.

  • Hypoplastic left heart syndrome (HLHS): HLHS is one of many types of single ventricle congenital heart disease. In this case, the left side of the heart is significantly underdeveloped which means the heart cannot pump enough blood and oxygen to the body. Babies with HLHS usually need their first of several major surgeries, the Norwood Operation, within the first few days or weeks of life. Alternative approaches, including the use of devices to limit blood flow to the lungs, can be used to optimize the baby’s condition before surgery.

Why Choose Lurie Children's for Neonatal Cardiac Surgery?

Nationally-ranked for cardiology and cardiac surgery, Lurie Children’s is a destination of excellence for the care of many young patients, including neonates and infants, with all types of heart conditions.

Our multidisciplinary neonatal services include the collaboration of fetal cardiologists with The Chicago Institute for Fetal Health, the Fetal Cardiology Program, pediatric cardiac surgeons, interventional cardiologists, cardiac anesthesiologists, cardiac intensive care doctors, cardiac imaging specialists, neonatal intensive care doctors and many other pediatric specialists. 

Our heart surgeons perform more than 450 surgeries each year, with one of the best survival rates for congenital heart surgery among the country’s 40 largest and most advanced children’s hospitals. We are home to Illinois’ most comprehensive and experienced pediatric heart transplant program.

Our cardiovascular-thoracic surgery team is led by David Winlaw, MBBS, MD, FRACS, an experienced heart surgeon with highly specialized skills in neonatal cardiac surgery. A prolific surgeon-scientist, Dr. Winlaw explores ways to identify causes and improve outcomes of congenital heart conditions in the smallest patients.

Neonatal Surgery Outcomes

Lurie Children’s heart surgeons have some of the best survival rates for heart surgery in the country.

Outcomes for all pediatric cardiac surgery are reported by the Society of Thoracic Surgeons using data submitted by each hospital performing this work. From this resource, we can compare outcomes at Lurie Children’s to national benchmarks.

Highlights of our outcomes include:

  • Better than expected outcomes for neonatal heart surgery with survival rates of 94.57% (actual) vs. 92.46% (predicted).
  • For complex operations, recorded in ‘STAT’ categories where categories 4 and 5 are the most complex:
    • STAT 5 neonatal survival at Lurie Children’s is 86.11%, compared to STS national benchmark of 84.81%
    • STAT 4 neonatal survival at Lurie Children’s is 95.35%, compared to STS national benchmark of 90.56%
  • Shorter lengths of stays for neonatal operations
    • Median length of stay at Lurie Children’s after the Norwood procedure is 40 days, compared to the STS national median of 60 days.
    • For the Arterial Switch Operation for Transposition of the Great Arteries, Lurie Children’s median length of stay is 11 days, compared to the STS national median of 18 days.

What to Expect

Before Surgery

Patients diagnosed with a congenital heart defect before birth will usually start their journey at The Chicago Institute for Fetal Health (CIFH) under the guidance of the Fetal Cardiology Program. The CIFH is a comprehensive center with experts who work together to diagnose and treat pregnant patients with fetal complications.

Patients will be set up to deliver at Prentice Women’s Hospital, the largest birthing center in the region. Lurie Children’s is directly via skybridge connected to Prentice Women’s Hospital, which allows us to provide immediate care for newborns who need urgent cardiac treatment, while keeping them close to their parents as they recover from delivery. This allows parents to easily see their baby even if they are still admitted to the hospital themself.

Soon after the baby is born and stabilized, they will be brought to the Regenstein Cardiac Care Unit (CCU) at Lurie Children’s. The CCU is a 44-bed acuity-adaptable unit for patients of all ages with congenital and acquired heart conditions; one of the only units of its kind in the country. The high-tech rooms adapt to the level of care the patient needs and eliminate the need to transfer the patient to other units in the hospital. Our rooms are technologically equipped for intensive care while providing the family amenities of a regular acute care patient room. Research shows that this unique care model greatly improves patient and family comfort, satisfaction and safety.

Each room is private, has a full bathroom, and has a pull-out couch for parents to stay overnight with their child. There will be a team of doctors, advanced practice provider, nurses, therapists, and more that will take specialized care of patient families’ and patients’ needs in the CCU. We encourage families to ask questions as they are a big part of a child’s care team.

Before neonatal cardiac surgery or a cardiac catheterization procedure, your child will undergo a comprehensive evaluation including laboratory testing, diagnostic imaging including echocardiogram, and multidisciplinary review at our weekly cardiac care conference. During the weekly care conference, our surgical and cardiology team will review all the pertinent data for your child to determine the most thoughtful plan for their upcoming surgery.

After Surgery

The recovery period after neonatal cardiac surgery can vary depending on the complexity of the surgery and the individual baby's health. The care team will provide an estimate of how long it will take your baby to recover or go home from the hospital depending on the surgery they had. However, there are some general things to expect.

In the Cardiac Care Unit

  • Baby will be closely monitored by a team of doctors, nurses and other healthcare professionals.
  • They will have several tubes and wires attached to them to monitor their heart function, breathing, and other vital signs.
  • They may be given medications to help their heart function and to prevent infection.
  • They will likely be fed through a nasogastric (NG) tube or an intravenous (IV) line until they are able to eat and drink on their own.

Going Home

  • Baby will be discharged from the hospital once their medical team determines together that it is safe for them to do so.
  • They may need to take several medications at home.
  • They will need to have regular follow-up appointments with their cardiologist.

It is important to be patient with the baby during recovery. It may take several months for them to fully recover from their surgery. Your Lurie Children’s care team can help provide support and care to your family throughout their surgery journey.

Other Concerns for Babies Requiring Neonatal Cardiac Surgery

Babies who undergo neonatal and infant heart surgery may experience delays in reaching developmental milestones. There are many potential causes for this, but fortunately there are many interventions available that can help these children overcome such obstacles to achieve a happy and fulfilling childhood. Lurie Children’s NICU-Cardiac Neurodevelopmental Program carefully monitors developmental milestones and emotional health and well-being while also helping families to access resources they may need such as speech, physical or occupational therapies.

This close collaboration between families and multidisciplinary team helps ensure that, despite their early medical challenges, these children can still reach their full potential. Advances in medical care and educational support systems are significantly improving long-term outcomes for this population.

Every child's journey is unique. The specific impacts of early heart surgery will depend on the severity of the CHD, the type of surgery and the quality of post-surgical care and support. With love, support and access to the comprehensive resources at Lurie Children’s Heart Center, these children can thrive and reach their full potential.

Our Neonatal Cardiac Surgery Team

The neonatal cardiac surgery team includes board-certified and board-eligible pediatric physicians with specialized training in the surgical treatment of heart conditions in infants and children. Physician assistants and nurse coordinators with special training in pediatrics and cardiology, along with specialists from the Lurie Children’s Cardiac Intensive Care Unit, Single Ventricle Center of Excellence and the NICU-Cardiac Neurodevelopmental Program round out the team.

Our Pediatric Cardiovascular-Thoracic Surgeons

David S. Winlaw, MBBS, MD, FRACS

Division Head, Cardiovascular-Thoracic Surgery; Co-Executive Director, Heart Center; Member, Lurie Children's Surgical Foundation; Willis J. Potts, MD Founders’ Board Professorship in Surgery

Osama M. Eltayeb, MD

Director, Vascular Rings Program; Director, Tracheal Reconstruction Program; Attending Physician, Cardiovascular-Thoracic Surgery; Member, Lurie Children's Surgical Foundation

Michael C. Mongé, MD

Surgical Director, Heart Failure/Heart Transplant Program; Attending Physician, Cardiovascular-Thoracic Surgery; Member, Lurie Children's Surgical Foundation

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Dr. David Winlaw, Head of the Division of Cardiovascular-Thoracic Surgery at Lurie Children’s, is renowned for his research in the field of congenital heart disease. 

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