Part II. Comparison of Neurodevelopmental Outcomes Between Normothermic and Hypothermic Pediatric Cardiopulmonary Bypass

Abstract

Objectives: In the previous study we demonstrated that normothermic cardiopulmonary bypass (N-CPB, ≥35°C) provided better early clinical outcomes compared to mild/moderate hypothermic cardiopulmonary bypass (H-CPB, 28–34°C) for congenital heart surgery. In this follow-up study we compare early neurodevelopmental outcomes 2–3 years post-surgery.Methods: In this retrospective, non-randomized observational study, the medical notes of children from our previous cohort were reviewed after 2–3 years. Demographic and neurodevelopmental outcomes were tabulated to enable blinded statistical analysis comparing outcomes between N-CPB and H-CPB surgery for congenital heart defects. Multivariate logistic regression models were developed to identify any differences in outcomes after adjustment for confounders.Results: Ninety-five children who underwent H-CPB (n = 50) or N-CPB (n = 45) were included. The proportions of patients with one or more adverse neurodevelopmental outcomes 2–3 years later were 14/50 (28.0%) in the H-CPB group and 11/45 (24.4%) in N-CPB, which was not significantly different between groups (p = 0.47). The two CPB groups were balanced for demographic and surgical risk factors, with the exception of genetic conditions. A higher incidence of H-CPB patients acquired learning difficulties [23.1% compared to 2.56% for N-CPB (p = 0.014)] and neurological deficits [30.8% compared to 7.69% for N-CPB (p = 0.019)], but these differences were not robust to adjustment for genetic syndromes.Conclusions: Our study did not reveal any significant differences in early neurodevelopmental outcomes between H-CPB or N-CPB surgery for congenital heart defects. The most important factor in predicting outcomes was, as expected, the presence of a genetic syndrome. We found no evidence that CPB temperature affects early neurodevelopmental outcomes.

Safety of Normothermic Cardiopulmonary Bypass in Pediatric Cardiac Surgery: A System Review and Meta-Analysis

“…Poncelet et al ( 11 ) conducted research on postoperative neurological complications in 18 children, with an average of 4 years of follow-up, after excluding those with related genetic diseases and multiple malformation syndromes and performed late neurological and neuropsychological evaluations and found no significant difference in the verbal intelligence quotient (IQ) ( P = 0.296), operational IQ ( P = 0.144), and total score IQ ( P = 0.065). Hannon et al ( 25 ) also exhibited greater neurodevelopmental delay, language delay, motor delay, learning difficulties, behavioral disorders, neurological deficits, and growth delay after cardiac surgery in the hypothermia group than in the normal temperature group. However, consistent with the results of studies conducted in humans and animals, which have been interpreted as suppression of brain tissue metabolism under HCPB, the present study does not provide obvious evidence that NCPB is superior to HCPB in protecting brain tissues from damage.…”

Strategies to attenuate maladaptive inflammatory response associated with cardiopulmonary bypass

“…A large-animal study recently showed hypothermic CPB attenuated platelet degranulation and coagulopathy and better maintained oxygenator performance in swine ( 249 ). Several RCTs studying pediatric populations showed normothermic CPB as noninferior to hypothermic CPB with endpoints including inotrope duration, intubation time, hospital stay, and early neurodevelopmental outcomes in low-risk populations ( 250 , 251 ).…”