Immediate postpartum cardiac surgery in neonates with critical congenital heart disease shows feasible outcomesFor newborns with critical heart defects, immediate surgery showed a 95% survival rate

ObjectiveTo 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.MethodsThis 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.ResultsThe 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.ConclusionWith 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.