Cardiac repair in patients with trisomy 18: Total or palliative?

Background: There are reports about cardiac surgery in patients with trisomy 18. However, total cardiac repair with bypass is limited in those patients. Objectives: We aimed to evaluate palliative cardiac surgery and compare it to total cardiac repair in patients with trisomy 18. Methods: Retrospectively, 11 patients’ medical records were reviewed. The patients were grouped as palliative surgery (3 patients), total repair followed by palliative surgery (6 patients), and one-stage total repair (2 patients). A total of 17 cardiac surgeries in all patients consisted of nine palliative surgeries and eight total cardiac repairs with bypass. The cumulative survival and post-operative outcomes including complications were investigated. Results: Eleven patients underwent 17 cardiac surgeries in total. Four patients survived, with a median age of 827.5 days. The survivors consisted of two after one-stage total repair and two after total repair followed by palliative surgery. No survivors were found after only palliative surgery. When post-operative outcomes after palliative surgery in nine patients were compared to those after total cardiac repair in eight patients, there were no differences in operative mortality, postoperative intensive care unit stay, and hospital stay. No differences in post-operative complications were found. Conclusions: For post-operative outcomes and survival, palliative surgery in patients with trisomy 18 was not different from total cardiac repair with bypass but involved a difficult postoperative course including various complications similar to those after total repair with bypass.