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Neurodevelopmental outcomes after congenital heart surgery and strategies for improvement

Tabbutt, Saraha; Gaynor, J. Williamb; Newburger, Jane W.c

Current Opinion in Cardiology: March 2012 - Volume 27 - Issue 2 - p 82–91
doi: 10.1097/HCO.0b013e328350197b
PEDIATRICS: Edited by Victoria L. Vetter

Purpose of review The present review focuses on neurodevelopmental and neuropsychologic outcomes following neonatal and infant heart surgery for complex congenital heart lesions. The data include recent reports on perioperative MRI and recent results of randomized clinical trials addressing perioperative variables.

Recent findings Advancements in magnetic resonance techniques have reinforced earlier data that newborns with complex congenital heart lesions are frequently born with brain immaturity. Randomized clinical trials have looked at several important perioperative candidate predictors as potential independent risk factors for worsened neurodevelopmental outcomes: no difference was found between regional cerebral perfusion and deep hypothermic circulatory arrest on 1-year outcomes; no difference was found between the modified Blalock–Taussig shunt and the right ventricular to pulmonary artery shunt as part of the Norwood procedure on 14-month outcomes; at 16-year testing for individuals with transposition of the great arteries following the arterial switch operation, no significant difference was found between low-flow cardiopulmonary bypass and deep hypothermic circulatory arrest.

Summary Randomized clinical, cross-sectional, and prospective trials have explored robust analyses looking for independent risk factors for worsened neurodevelopmental outcomes. Most of these risk factors are patient-related or socioeconomic, with only a few potentially modifiable.

aUniversity of California San Francisco Benioff Children's Hospital, San Francisco, California

bChildren's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

cBoston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA

Correspondence to Sarah Tabbutt, MD, PhD, Director Cardiac Intensive Care, Associate Professor of Pediatrics, M-680, UCSF Benioff Children's Hospital, 505 Parnassus Ave, San Francisco, CA 94143, USA. Tel: +415 476 5153; e-mail: tabbutts@peds.ucsf.edu

© 2012 Lippincott Williams & Wilkins, Inc.