HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): J. William Gaynor Thomas L. Spray Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gaynor, J. W. Articles by Spray, T. L. Search for Related Content PubMed PubMed Citation Articles by Gaynor, J. W. Articles by Spray, T. L. Related Collections Congenital - acyanotic Congenital - cyanotic Extracorporeal circulation Related Article

J Thorac Cardiovasc Surg 2007;133:1344-1353
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Patient characteristics are important determinants of neurodevelopmental outcome at one year of age after neonatal and infant cardiac surgery

^a Division of Cardiothoracic Surgery, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pa
^b Division of Pediatric Cardiology, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pa
^d Division of General Pediatrics, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pa
^e Division of Psychology, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pa
^f Division of Genetics, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pa
^g Division of Neurology, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pa
^h Division of Cardiothoracic Anesthesiology, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pa
^c Department of Medicine (Medical Genetics), University of Washington, Seattle, Wash.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.

Received for publication May 15, 2006; revisions received October 12, 2006; accepted for publication October 25, 2006.

^_* Address for reprints: J. William Gaynor, MD, Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Suite 8527, Philadelphia, PA 19104. (Email: gaynor{at}email.chop.edu).

Objective: Many studies of neurodevelopmental outcomes after neonatal and infant cardiac surgery have focused on potentially modifiable risk factors for adverse outcomes, primarily intraoperative management strategies and the use of deep hypothermic circulatory arrest. There is increasing evidence that patient-specific factors are more important determinants of outcome.

Methods: We investigated predictors of neurodevelopmental outcomes at 1 year of age after neonatal and infant cardiac surgery in a subgroup of infants enrolled in a prospective study of apolipoprotein E (APOE) genotype and neurodevelopmental outcome. Children with a variety of 2-ventricle cardiac defects repaired with only 1 operation with cardiopulmonary bypass and no more than 1 episode of deep hypothermic circulatory arrest were included. Neurodevelopmental outcomes at 1 year of age included the Bayley Scales of Infant Development-II, which yield 2 indices, the Mental Developmental Index and the Psychomotor Developmental Index.

Results: Two hundred forty-seven infants underwent surgical repair between October 1998 and April 2003 with 1 hospital death and 3 deaths before 1 year of age. Neurodevelopmental evaluation was performed in 188 (77%) of 243 survivors, including 56 patients with tetralogy of Fallot, 39 with transposition of the great arteries with intact ventricular septum, 34 with ventricular septal defects, and 59 with other defects. The median age at operation was 56 days (1–186 days), including 72 (38%) neonates. Confirmed or suspected genetic syndromes were present in 59 (31%) of 188 infants. Deep hypothermic circulatory arrest was used in 67 (35%) infants with a median duration of 34 minutes (1-80 minutes). For the entire cohort, the mean Mental Developmental Index was 90.6 ± 14.9 and the mean Psychomotor Developmental Index was 81.6 ± 17.2. For patients without genetic syndromes, the mean Mental Developmental Index was 93.7 ± 13.6 and the mean Psychomotor Developmental Index was 85.1 ± 14.6. For the entire cohort, predictors of lower scores for both the Mental Developmental Index and Psychomotor Developmental Index were presence of a confirmed or suspected genetic syndrome, lower birth weight, and presence of the APOE 2 allele (all P < .04). Black race was associated with higher scores on the Psychomotor Developmental Index (P = .018). Lower nasopharyngeal temperature during cardiopulmonary bypass was associated with a lower score on the Psychomotor Developmental Index (P = .03) and was the only intraoperative factor that was a significant predictor of either the Mental or Psychomotor Developmental Index.

Conclusions: The strongest predictors of a worse neurodevelopmental outcome at 1 year of age were patient-specific factors including presence of a genetic syndrome, low birth weight, and presence of the APOE 2 allele. Patient-specific factors eclipsed the use and duration of deep hypothermic circulatory arrest as predictors of worse neurodevelopmental outcomes.

Related Article

Discussion
J. Thorac. Cardiovasc. Surg. 2007 133: 1351-1353. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				C. A. Joynt, C. M.T. Robertson, P.-Y. Cheung, A. Nettel-Aguirre, A. R. Joffe, R. S. Sauve, W. S.G. Biggs, N. J. Leonard, D. B. Ross, I. M. Rebeyka, et al. Two-year neurodevelopmental outcomes of infants undergoing neonatal cardiac surgery for interrupted aortic arch: A descriptive analysis J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 924 - 932. [Abstract] [Full Text] [PDF]

				G. Van Arsdell Invited commentary. Ann. Thorac. Surg., September 1, 2009; 88(3): 829 - 829. [Full Text] [PDF]

				S. Fuller, A. S. Nord, M. Gerdes, G. Wernovsky, G. P. Jarvik, J. Bernbaum, E. Zackai, and J. W. Gaynor Predictors of impaired neurodevelopmental outcomes at one year of age after infant cardiac surgery Eur. J. Cardiothorac. Surg., July 1, 2009; 36(1): 40 - 48. [Abstract] [Full Text] [PDF]

				J. Beca, J. Gunn, L. Coleman, A. Hope, L.-C. Whelan, T. Gentles, T. Inder, R. Hunt, and L. Shekerdemian Pre-operative brain injury in newborn infants with transposition of the great arteries occurs at rates similar to other complex congenital heart disease and is not related to balloon atrial septostomy. J. Am. Coll. Cardiol., May 12, 2009; 53(19): 1807 - 1811. [Abstract] [Full Text] [PDF]

				R. G. Ohye, C. S. Goldberg, J. Donohue, J. C. Hirsch, M. Gaies, M. L. Jacobs, J. G. Gurney, and Michigan Congenital Heart Outcomes Research and Di The quest to optimize neurodevelopmental outcomes in neonatal arch reconstruction: The perfusion techniques we use and why we believe in them J. Thorac. Cardiovasc. Surg., April 1, 2009; 137(4): 803 - 806. [Full Text] [PDF]

				D. J. Licht, D. M. Shera, R. R. Clancy, G. Wernovsky, L. M. Montenegro, S. C. Nicolson, R. A. Zimmerman, T. L. Spray, J. W. Gaynor, and A. Vossough Brain maturation is delayed in infants with complex congenital heart defects. J. Thorac. Cardiovasc. Surg., March 1, 2009; 137(3): 529 - 536. [Abstract] [Full Text] [PDF]

				K. Watanabe, M. Matsui, J. Matsuzawa, C. Tanaka, K. Noguchi, N. Yoshimura, K. Hongo, M. Ishiguro, S. Wanatabe, K. Hirono, et al. Impaired neuroanatomic development in infants with congenital heart disease. J. Thorac. Cardiovasc. Surg., January 1, 2009; 137(1): 146 - 153. [Abstract] [Full Text] [PDF]

				H. L. Walters III, C. E. Ionan, R. L. Thomas, and R. E. Delius Single-stage versus 2-stage repair of coarctation of the aorta with ventricular septal defect. J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 754 - 761. [Abstract] [Full Text] [PDF]

				A. J. Shillingford, M. M. Glanzman, R. F. Ittenbach, R. R. Clancy, J. W. Gaynor, and G. Wernovsky Inattention, Hyperactivity, and School Performance in a Population of School-Age Children With Complex Congenital Heart Disease Pediatrics, April 1, 2008; 121(4): e759 - e767. [Abstract] [Full Text] [PDF]

				G. Wernovsky Improving neurologic and quality-of-life outcomes in children with congenital heart disease: Past, present, and future J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 240 - 242. [Full Text] [PDF]

				I. Zeltser, G. P. Jarvik, J. Bernbaum, G. Wernovsky, A. S. Nord, M. Gerdes, E. Zackai, R. Clancy, S. C. Nicolson, T. L. Spray, et al. Genetic factors are important determinants of neurodevelopmental outcome after repair of tetralogy of Fallot J. Thorac. Cardiovasc. Surg., January 1, 2008; 135(1): 91 - 97. [Abstract] [Full Text] [PDF]