Outcomes of heart surgery in neonates with trisomy 13 and 18: a systematic review with metanalysis.

Abstract

This systematic review and meta-analysis aimed to evaluate the clinical outcomes of cardiac surgery in neonates with trisomy 13 (T13) or trisomy 18 (T18) compared to those managed with palliative care. A literature search was conducted in PubMed® and EMBASE®, following PRISMA guidelines, and included five retrospective cohort studies (1627 patients). Outcomes analyzed included in-hospital mortality, survival at 12 months, length of stay (LOS), hospital discharge rates, and the need for mechanical ventilation. The meta-analysis showed that cardiac surgery significantly reduced the odds of in-hospital mortality (OR 0.12, CI 95% 0.03-0.42, p < 0.01), increased survival at 12 months (OR 19.77, CI 95% 5.12-76.36, p < 0.01), and improved discharge rates (OR 12.53, CI 95% 3.63-43.22, p < 0.01). However, limited data were available on quality of life and mechanical ventilation duration. Conclusion: Despite the positive impact of cardiac surgery on survival and discharge rates, the evidence remains low quality, as the included studies were primarily retrospective cohorts with moderate risk of bias. The findings highlight the importance of involving families in the decision-making process, given their differing perspectives on quality of life. Further high-quality studies, such as randomized controlled trials, are needed to provide stronger evidence on this topic.