Neurocognitive, Functional, and Health Outcomes at 5 Years of Age for Children After Complex Cardiac Surgery at 6 Weeks of Age or Younger

Creighton, Dianne; Robertson, Charlene M.T.; Sauvé, Reg; Moddemann, Diane; Alton, Gwen Y.; Nettel-Aguirre, Alberto; Rebeyka, Ivan M.

doi:10.1542/peds.2006-3250

Cited by 90 publications

(88 citation statements)

References 42 publications

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“…39 For children after Norwood MBTS surgery, a strong correlation has been found between the MDI at 18 to 24 months of age and full-scale intelligence scores at 5 years of age. 41 In the present study cohort, MDI scores and the incidence of mental delay did not improve in the recent surgical era. Linear regression analysis identified a lower socioeconomic status and prolonged hospitalization at the time of the Norwood procedure as independent predictors of lower mental scores in the MBTS era.…”

Section: Mental and Psychomotor Outcomescontrasting

confidence: 48%

Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure

Atallah

Dinu²,

Joffe³

et al. 2008

Circulation

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Background-The Norwood procedure for stage 1 palliation of hypoplastic left heart syndrome is performed with either the modified Blalock-Taussig (MBTS) or the right ventricle-to-pulmonary artery (RVPA) shunt. In our institution, surgical practice changed from use of the MBTS to use of the RVPA shunt in 2002. We analyzed survival and mental and psychomotor outcomes of the 2 consecutive surgical eras. Methods and Results-Between September 1996 and July 2005, 94 neonates with hypoplastic left heart syndrome underwent the Norwood procedure. Patients were recruited as neonates and followed up prospectively. Health, mental, and psychomotor outcomes (Bayley Scales of Infant Development-II) were assessed at 2 years. The study subjects were from the Norwood-MBTS era (nϭ62; 1996 to 2002) or the Norwood-RVPA era (nϭ32; 2002 to 2005). In the MBTS era, early and 2-year mortality rates were 23% (14/62) and 52% (32/62); the mean (SD) mental and psychomotor developmental indices were 79 (18) and 67 (19). In the RVPA era, early and 2-year mortality rates were 6% (2/32) and 19% (6/32); the mean (SD) mental and psychomotor developmental indices were 85 (18) and 78 (18). The 2-year mortality rate (Pϭ0.002) and the psychomotor developmental index (Pϭ0.029) were improved in the more recent surgical era. On multivariable Cox regression analysis, postoperative highest serum lactate independently predicted 2-year mortality in the MBTS and RVPA eras. Conclusions-Analysis of 2 consecutive surgical eras of hypoplastic left heart syndrome patients undergoing the Norwood procedure showed a significant improvement in 2-year survival and psychomotor development in the more recent era.

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Section: Mental and Psychomotor Outcomescontrasting

confidence: 48%

Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure

Atallah

Dinu²,

Joffe³

et al. 2008

Circulation

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“…50 In comparison with normative populations, survivors of infant heart surgery have more problems with reasoning, learning, executive function, inattention and impulsive behavior, language skills, and social skills. [51][52][53] The past decade has heightened awareness of neurocognitive challenges in children with CHD, and American Heart Association recommendations now provide guidance to pediatric caregivers about the need for regular screening for those at high risk. Nucleosome with histone octamer and DNA, with H3K4 methylation bound by CHD7, H3K27 methylation, and H2BK120 ubiquitination is shown.…”

Section: Neurodevelopment In Chdmentioning

confidence: 99%

Trends in Congenital Heart Disease

2016

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“…5,7,9 This may be attributable to the fact that full-flow cardiopulmonary bypass (CPB) is not feasible during the reconstruction of the aortic arch, obligating the use of either deep hypothermic circulatory arrest (DHCA) or antegrade cerebral perfusion (ACP). Despite initial reports on the adverse cerebral effects after DHCA and the intuitive benefit of ACP, previous studies have not been able to show superiority of ACP in studies of neurodevelopmental outcome at 1 year of age.…”

Section: Clinical Perspective On P 233mentioning

confidence: 99%

Neurological Injury After Neonatal Cardiac Surgery

et al. 2014

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S urvival after neonatal cardiac surgery has improved over the past decades to >90% because of major advances in surgical techniques and perioperative management. However, it has also become evident that neurodevelopment is impaired in approximately one third of children who underwent surgery at a neonatal age.1 As seen on magnetic resonance imaging (MRI), 23% to 40% of neonates presenting with a complex cardiac defect already have evidence of cerebral injury preoperatively.2-6 After surgery, 36% to 73% of patients have evidence of new cerebral lesions on MRI. [2][3][4][5][6][7][8] This suggests that much of the injury develops perioperatively. Clinical Perspective on p 233Neonates diagnosed with aortic arch obstruction (ie, hypoplastic left heart syndrome or other complex cardiac defects) are consistently at the highest risk of cerebral injury. 5,7,9 This may be attributable to the fact that full-flow cardiopulmonary bypass (CPB) is not feasible during the reconstruction of the aortic arch, obligating the use of either deep hypothermic circulatory arrest (DHCA) or antegrade cerebral perfusion (ACP). Despite initial reports on the adverse cerebral effects after DHCA and the intuitive benefit of ACP, previous studies have not been able to show superiority of ACP in studies of neurodevelopmental outcome at 1 year of age. 10,11 However, these results may be confounded by the reoperations that frequently take place in the interim.Therefore, in the present randomized, controlled trial, we used preoperative and postoperative MRI as the most sensitive measure to assess perioperative cerebral injury. Specifically, in neonates undergoing aortic arch reconstruction, the incidence of new postoperative injury on MRI was compared between DHCA and ACP.Background-Complex neonatal cardiac surgery is associated with cerebral injury. In particular, aortic arch repair, requiring either deep hypothermic circulatory arrest (DHCA) or antegrade cerebral perfusion (ACP), entails a high risk of perioperative injury. It is unknown whether ACP results in less cerebral injury than DHCA. Methods and Results-Thirty-seven neonates with an aortic arch obstruction presenting for univentricular or biventricular repair were randomized to either DHCA or ACP. Preoperatively and 1 week after surgery, magnetic resonance imaging was performed in 36 patients (1 patient died during the hospital stay). The presence of new postoperative cerebral injury was scored, and results were entered into a sequential analysis, which allows for immediate data analysis. After the 36th patient, it was clear that there was no difference between DHCA and ACP in terms of new cerebral injury. Preoperatively, 50% of patients had evidence of cerebral injury.

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Neurocognitive, Functional, and Health Outcomes at 5 Years of Age for Children After Complex Cardiac Surgery at 6 Weeks of Age or Younger

Cited by 90 publications

References 42 publications

Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure

Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure

Trends in Congenital Heart Disease

Neurological Injury After Neonatal Cardiac Surgery

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