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J Thorac Cardiovasc Surg 2002;124:425-427
© 2002 The American Association for Thoracic Surgery

Editorials

Developmental and neurologic outcomes late after neonatal corrective surgery

From the Department of Cardiac Surgery, Children's Hospital, Harvard Medical School, Boston, Mass.

Received for publication Jan 24, 2002. Accepted for publication Feb 10, 2002. Address for reprints: Pedro J. del Nido, MD, Department of Cardiac Surgery, Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (E-mail: Pedro.delnido@tch.harvard.edu).

The first 20% of the full text of this article appears below.

	Introduction

 
See related article on page 448.

With the many advances in treatment of congenital heart defects, including prenatal detection, improved perioperative management, and surgical technique, operative results for most complex congenital heart lesions requiring neonatal intervention have steadily improved. Now that operative mortality is low for many lesions, the focus has shifted from assessment of short-term results to measures of late functional outcome, including assessment of hemodynamic and neurodevelopmental statuses. Investigators in this field have recognized, however, that the wide range of anatomic defects treated may have direct and indirect effects on late outcomes, making the design of experiments aimed at evaluating specific management techniques difficult, and these studies often require a large cohort to establish statistical power. The group of infants born with the D-transposition of the great arteries represents a unique study cohort in that the anatomic defect results in a predictable clinical presentation and the preoperative and surgical management have now become standardized in most institutions. At best, the uniformity of age, low incidence of associated important hemodynamic defects, standardized surgical technique, and very low rate of associated noncardiac genetic defects makes this an ideal group for both retrospective and prospective randomized trials. Thus many clinical trials studying the effects of specific surgical techniques, such as the use of deep hypothermic circulatory arrest, ¹ pH management on bypass, ² and degree of hemodilution, have been done in this particular patient population. Despite the apparent homogeneity of this group however, it is important to recognize that there are a number of uncontrolled clinical variables that may significantly affect the . . . [Full Text of this Article]

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