Developmental and Neurological Status of Children at 4 Years of Age After Heart Surgery With Hypothermic Circulatory Arrest or Low-Flow Cardiopulmonary Bypass

Bellinger, David C.; Wypij, David; Kuban, Karl; Rappaport, Leonard; Hickey, Paul R.; Wernovsky, Gil; Jonas, Richard A.; Newburger, Jane W.

doi:10.1161/01.cir.100.5.526

Cited by 534 publications

(412 citation statements)

References 29 publications

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“…6,13 Our study suggests that children and adolescents surviving repair of TGA seem to be functioning well, both physically and psychosocially. Our study population scored significantly higher than published norms in all categories except selfesteem.…”

Section: Discussionmentioning

confidence: 71%

“…Others have shown that use of circulatory arrest during TGA repair is associated with fine and gross motor deficits but is generally well tolerated, with no cognitive or other neurologic deficits identified by formal testing. 13,27 By multivariable regression, our study revealed that perfusion parameters may be important in behavior and social limits concepts. Use of circulatory arrest, but not duration, was associated with lower CHQ scores, suggesting that any period of cerebral ischemia may be detrimental.…”

Section: Discussionmentioning

confidence: 77%

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Quality of Life of Children After Repair of Transposition of the Great Arteries

Culbert

Ashburn²,

Cullen-Dean³

et al. 2003

Circulation

110

104

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Background— We sought to assess quality of life of children with transposition of the great arteries (TGA) enrolled during transition in management strategy from atrial to arterial switch operation. Methods and Results— Neonates enrolled by the Congenital Heart Surgeons Society in a prospective study of TGA between 1985 and 1989 were eligible. A Child Health Questionnaire was sent for completion by the child between February and June 2000. Data were compared with published normative values. Child Health Questionnaires were completed by 306 of 708 survivors at a mean age of 13±1 years. Diagnosis included TGA (n=202, 66%), TGA/ventricular septal defect (VSD) (n=84, 27%), and TGA/VSD/pulmonary stenosis (n=20, 7%). Repair type was arterial switch (n=189, 62%), atrial switch (n=105, 34%; Senning=58, Mustard=47), or Rastelli (n=12, 4%). Children with TGA scored significantly higher than published norms in all categories except self-esteem. TGA/VSD/pulmonary stenosis was associated with lower scores than TGA and TGA/VSD in physical functioning ( P =0.002), general health perceptions ( P =0.012), and mental health ( P =0.048). Arterial repair was associated with higher scores than atrial or Rastelli repair in physical functioning ( P <0.001), pain ( P =0.004), mental health ( P =0.019), self-esteem ( P =0.004), and general health perceptions ( P <0.001). By multivariable analyses, the most common independent factors impacting scores were repair type, perfusion parameters, and gender. Conclusions— Quality of life and health status as perceived by children 11 to 15 years after TGA repair is excellent when compared with published normative data and is better after arterial switch operation than after atrial repair.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 77%

Quality of Life of Children After Repair of Transposition of the Great Arteries

Culbert

Ashburn²,

Cullen-Dean³

et al. 2003

Circulation

110

104

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“…While several studies have explored late neurodevelopmental outcomes2, 3, 4, 5 and exercise training on older patients with CHD after surgery,10, 11, 12, 13, 14, 15 little has been published on the acute impact on functional status following CHD surgery, and the associated RT use in the immediate postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Postoperative Rehabilitation Therapy Following Congenital Heart Surgery

Tikkanen

Nathan

Sleeper

et al. 2018

JAHA

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BackgroundPatients with congenital heart disease are at risk of motor, cognitive, speech, and feeding difficulties after cardiac surgery. Rehabilitation therapy could improve functional outcomes in this population if applied in the acute postcardiac surgical in‐hospital stay. However, information on the types of acute postcardiac surgery therapy needs in children is scarce. Our goal was to describe rehabilitation therapy following congenital heart surgery and pre/intraoperative factors associated with need for therapy.Methods and ResultsThis is a retrospective cohort study of patients <18 years undergoing heart surgery at our center from January 1, 2013 to January 31, 2015. Demographic, and pre‐, intra‐, and postoperative clinical and rehabilitation therapy (physical, occupational, speech, feeding therapy, and neurodevelopment intervention) data were collected. Need for rehabilitation therapy in the acute postoperative period, particularly following palliative repair, was the outcome variable in a multivariable logistic regression model to identify independent pre‐ and intraoperative factors associated with therapy. A total of 586 out of 1415 (41%) subjects received rehabilitation therapy postsurgery. Certain subgroups had increased rehabilitation therapy use such as neonates (80%). On multivariable analysis, palliative repair, prematurity, genetic syndrome, presurgical hospital stay of more than 1 day, and prolonged cardiopulmonary bypass time were independently associated with rehabilitation therapy.ConclusionsNearly half of patients who underwent post–congenital heart surgery received rehabilitation therapy. Frequency of use and types of therapy vary according to patient characteristics; however, certain pre‐ and intraoperative factors are associated with need for rehabilitation therapy, and may aid decision‐making for appropriate resource allocation.

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“…some of the neurological findings that may be observed are seizures, alterations of consciousness, behavioral disorders, intellectual impairment, focal deficit, involuntary movements, and lesions to the periph-Neuropsychomotor development open-heart surgery in infants rocha et al eral nervous system. recent studies have assessed the influence of diverse circulatory bypass techniques on the neuropsychomotor development of newborns with transposition of the great arteries [1][2][3][4][5][6] . More recently, the repercussions of circulatory bypass and moderate hypothermia for the correction of common defects, such as septal defects and tetralogy of Fallot, have been studied [7][8][9][10] .…”

Section: Dra Taís Sica Da Rocha -Rua Farias Santos 500/301 -90670-15mentioning

confidence: 99%

“…Mestre em ciências Médicas, Pediatria Universidade Federal do rio Grande do sul, Porto Alegre rs, Brazil; 2 Neurologista Pediátrica, Professora Adjunta da Universidade Federal de ciências da saúde de Porto Alegre, Porto Alegre rs, Brazil; 3 Intensivista Pediátrico, Professor Adjunto da Universidade do rio Grande do sul, Porto Alegre rs, Brazil; 4 Intensivista Pediátrico da Unidade de Terapia Intensiva do Hospital da criança santo Antônio -complexo Hospitalar santa casa de Porto Alegre, Porto Alegre rs, Brazil; 5 cirurgião cardíaco Pediátrico, serviço de cirurgia cardíaca do complexo Hospitalar santa casa de Porto Alegre, Porto Alegre rs, Brazil. …”

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Neuropsychomotor development before and after open-heart surgery in infants

Rocha

Guardiola

Piva

et al. 2009

Arq. Neuro-Psiquiatr.

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-There are few Brazilian studies on neuropsychomotor follow-up after open-heart surgery with circulatory bypass in infants. Twenthy infants had neurodevelopmental outcomes (neurological exam and Denver II test) assessed before open-heart surgery, after intensive care unit discharge and 3-6 months after hospital discharge. Heart lesions consisted of septal defects in 11 cases (55%). The mean circulatory bypass time was 67±23.6 minutes. Fifteen infants had altered neurological examination and also neurodevelopment delay before surgery. After 6 months it was observed normalization in 6 infants. When Denver II test indexes were analysed, it was observed an improvement in all domains except personal-social. Although those infants were in risk of new neurological findings, an early improvement on neuropsychomotor indexes were seen.Key WorDs: cardiac surgery, developmental delay, Denver II test.desenvolvimento neuropsicomotor de lactentes antes e após cirurgia cardíaca resumo -As alterações neurológicas em lactentes com cardiopatia congênita podem agravar seu quadro clínico e levar a seqüelas permanentes. Foi realizada uma coorte prospectiva, com 20 lactentes, com idade média de 6,7±4,2 meses, avaliando-se o perfil de desenvolvimento e o estado nutricional. Utilizou-se o exame neurológico e o teste de Denver II. os testes foram aplicados 24h antes da cirurgia, na alta da unidade de terapia intensiva e 3 a 6 meses após. os defeitos septais ocorreram em 11 casos (55%). o tempo médio de circulação extra-corpórea foi de 67±23,6 minutos. Quinze crianças tinham exame neurológico alterado e atraso no desenvolvimento neuropsicomotor antes da cirurgia, cuja normalização foi observada somente em seis após 6 meses .Quanto aos índices de Denver II, houve aumento em todos domínios, exceto o pessoalsocial. o escore Z médio para peso antes da cirurgia foi -2,814±1,98 e após -1,08±1,47 (p<0.05), o qual foi realizado em média 5.2±1.5 meses após a alta hospitalar. Melhora precoce tanto no desenvolvimento como no estado nutricional pôde ser observada neste grupo de lactentes após a correção cirúrgica.PAlAvrAs-cHAve: cirurgia cardíaca, atraso no desenvolvimento neurológico, teste de Denver II, cardiopatia congênita. corrective cardiac surgery involves a series of complex and high risk procedures and a large number of them expose the brain to hypoxic ischemic insults 1 . Prospective studies have shown that 100% of children who undergo cardiac surgery present with central nervous system dysfunctions in the immediate post-operative period 2 as a consequence of alterations in the cerebral blood flow. If the hypoxic ischemic insult is acute and extensive, the patients may not regain consciousness in the immediate post-operative period and stand increased chances of irreversible sequelae. some of the neurological findings that may be observed are seizures, alterations of consciousness, behavioral disorders, intellectual impairment, focal deficit, involuntary movements, and lesions to the periph-

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Developmental and Neurological Status of Children at 4 Years of Age After Heart Surgery With Hypothermic Circulatory Arrest or Low-Flow Cardiopulmonary Bypass

Abstract: Use of CA to support vital organs during open heart surgery in infancy is associated, at the age of 4 years, with worse motor coordination and planning but not with lower IQ or with worse overall neurological status.

Cited by 534 publications

References 29 publications

Quality of Life of Children After Repair of Transposition of the Great Arteries

Quality of Life of Children After Repair of Transposition of the Great Arteries

Predictors of Postoperative Rehabilitation Therapy Following Congenital Heart Surgery

Neuropsychomotor development before and after open-heart surgery in infants

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