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J Thorac Cardiovasc Surg 2003;126:1385-1396
© 2003 The American Association for Thoracic Surgery
Surgery for congenital heart disease |
a Department of Neurology, Children's Hospital, Boston, Mass, USA
b Department of Cardiology, Children's Hospital, Boston, Mass, USA
c Department of Medicine, Children's Hospital, Boston, Mass, USA
d Department of Cardiovascular Surgery, Children's Hospital, Boston, Mass, USA
e Clinical Research Program,e Children's Hospital, Boston, Mass, USA
f Department of Neurology, Harvard Medical School, Boston, Mass, USA
g Department of Pediatrics, Harvard Medical School, Boston, Mass, USA
h Department of Surgery, Harvard Medical School, Boston, Mass, USA
i Department of Biostatistics, Harvard School of Public Health, Boston, Mass, USA
Received for publication June 6, 2002; revisions received August 20, 2002; revisions received March 17, 2003; accepted for publication March 27, 2003.
* Address for reprints: David C. Bellinger, PhD, MSc, Neuroepidemiology Unit, Farley Basement 127, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
david.bellinger{at}tch.harvard.edu
OBJECTIVES: Our goal was to determine which of the two major methods of vital organ support used in infant cardiac surgery, total circulatory arrest and low-flow cardiopulmonary bypass, results in better neurodevelopmental outcomes at school age.
METHODS: In a single-center trial, infants with dextrotransposition of the great arteries underwent the arterial switch operation after random assignment to either total circulatory arrest or low-flow cardiopulmonary bypass. Developmental, neurologic, and speech outcomes were assessed at 8 years of age in 155 of 160 eligible children (97%).
RESULTS: Treatment groups did not differ in terms of most outcomes, including neurologic status, Full-Scale or Performance IQ score, academic achievement, memory, problem solving, and visual-motor integration. Children assigned to total circulatory arrest performed worse on tests of motor function including manual dexterity with the nondominant hand (P = .003), apraxia of speech (P = .01), visual-motor tracking (P = .01), and phonologic awareness (P = .003). Assignment to low-flow cardiopulmonary bypass was associated with a more impulsive response style on a continuous performance test of vigilance (P < .01) and worse behavior as rated by teachers (P = .05). Although mean scores on most outcomes were within normal limits, neurodevelopmental status in the cohort as a whole was below expectation in many respects, including academic achievement, fine motor function, visual-spatial skills, working memory, hypothesis generating and testing, sustained attention, and higher-order language skills.
CONCLUSIONS: Use of total circulatory arrest to support vital organs during heart surgery in infancy is generally associated with greater functional deficits than is use of low-flow cardiopulmonary bypass, although both strategies are associated with increased risk of neurodevelopmental vulnerabilities.
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L. Wise-Faberowski, H. Zhang, R. Ing, R. D. Pearlstein, and D. S. Warner Isoflurane-Induced Neuronal Degeneration: An Evaluation in Organotypic Hippocampal Slice Cultures Anesth. Analg., September 1, 2005; 101(3): 651 - 657. [Abstract] [Full Text] [PDF]
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I. Hagino, V. Anttila, D. Zurakowski, L. F. Duebener, H. G.W. Lidov, and R. A. Jonas Tissue oxygenation index is a useful monitor of histologic and neurologic outcome after cardiopulmonary bypass in piglets J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 384 - 392. [Abstract] [Full Text] [PDF]
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 S. G Raja, A. Shauq, and M. Kaarne Outcomes after Arterial Switch Operation for Simple Transposition Asian Cardiovasc Thorac Ann, June 1, 2005; 13(2): 190 - 198. [Abstract] [Full Text] [PDF]
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A. Undar, W R. Owens, M. C. McGarry, D. L Surprise, V. D Kilpack, M. W Mueller, E D. McKenzie, and C. D Fraser Jr Comparison of hollow-fiber membrane oxygenators in terms of pressure drop of the membranes during normothermic and hypothermic cardiopulmonary bypass in neonates Perfusion, May 1, 2005; 20(3): 135 - 138. [Abstract] [PDF]
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P. M. Kirshbom, T. B. Flynn, R. R. Clancy, R. F. Ittenbach, D. M. Hartman, S. M. Paridon, G. Wernovsky, T. L. Spray, and J. W. Gaynor Late neurodevelopmental outcome after repair of total anomalous pulmonary venous connection J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 1091 - 1097. [Abstract] [Full Text] [PDF]
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A. Dodge-Khatami, A. Kadner, F. Berger, H. Dave, M. I. Turina, and R. Pretre In the Footsteps of Senning: Lessons Learned From Atrial Repair of Transposition of the Great Arteries Ann. Thorac. Surg., April 1, 2005; 79(4): 1433 - 1444. [Abstract] [Full Text] [PDF]
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E. McGrath, D. Wypij, L. A. Rappaport, J. W. Newburger, and D. C. Bellinger Prediction of IQ and Achievement at Age 8 Years From Neurodevelopmental Status at Age 1 Year in Children With D-Transposition of the Great Arteries Pediatrics, November 1, 2004; 114(5): e572 - e576. [Abstract] [Full Text] [PDF]
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T. P. Graham Jr The year in congenital heart disease J. Am. Coll. Cardiol., June 2, 2004; 43(11): 2132 - 2141. [Full Text] [PDF]
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A. F. Corno A lost opportunity. J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1857 - 1858. [Full Text] [PDF]
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R. H. Jones The year in cardiovascular surgery J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1706 - 1714. [Full Text] [PDF]
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R. M. Ungerleider and J. W. Gaynor The Boston Circulatory Arrest Study: An analysis J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1256 - 1261. [Full Text] [PDF]
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