Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations
Open accessAbstract
Background Neurodevelopmental disability is common after operations for congenital heart defects. We previously showed that patient and preoperative factors, center, and calendar year of birth explained less than 30% of the variance for the Psychomotor Development Index (PDI) and the Mental Development Index (MDI) of the Bayley Scales of Infant Development-Second Edition. Here we investigate how much additional variance in PDI and MDI is contributed by operative variables and postoperative events.Methods We analyzed neurodevelopmental outcomes after operations with cardiopulmonary bypass at age 9 months or younger between 1996 and 2009. We used linear regression to investigate the effect of operative factors (age, weight, and cardiopulmonary bypass variables) and postoperative events on neurodevelopmental outcomes, adjusting for center, type of congenital heart defect, year of birth, and preoperative factors.Results We analyzed 1,770 children from 22 institutions with neurodevelopmental testing at age 13.3 months (range, 6 to 30 months). Among operative factors, longer total support time was associated with lower PDI and MDI (p < 0.05). When postoperative events were added, use of either extracorporeal membrane oxygenation or ventricular assist device support, and longer postoperative length of stay were associated with lower PDI and MDI (p < 0.05). Longer total support time was not a significant predictor in these models. After adjusting for patient, preoperative, intraoperative, and postoperative factors, measured intraoperative and postoperative factors accounted for 5% of the variances in PDI and MDI.Conclusions Operative factors may be less important than innate patient and preoperative factors and postoperative events in predicting early neurodevelopmental outcomes after cardiac operations in infants. Neurodevelopmental outcomes improved over calendar time when adjusted for patient and medical variables.
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Survivors of early-life cardiac surgery continue to show neurodevelopmental deficits.
“However, survivors of early-life cardiac surgery continue to show neurodevelopmental deficits.2”
From Perioperative neonatal brain injury is associated with worse school-age neurodevelopment in children with critical congenital heart disease (2018) · cites this paper as [2]
Patients with single ventricle pathology have longer postoperative stay, more additional operations, and more frequent cardiopulmonary resuscitation and extracorporeal membrane oxygenation than patients with transposition of the great arteries, but incidences of acquired brain injury are similar between the two groups.
“Patients with SVP show longer length of postoperative stay, more additional operations, more often cardiopulmonary resuscitation and extracorporal membrane oxygenation than patients with TGA, 82 but incidences of acquired brain injury are similar between the two groups.59,83”
From Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease (2017) · cites this paper as [82]
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- Authors
- Gaynor, J. W., Stopp, C., Wypij, D., Andropoulos, D. B., Atallah, J., Atz, A. M., Beca, J., Donofrio, M. T., Duncan, K., Ghanayem, N. S., Goldberg, C. S., Hövels-Gürich, H., Ichida, F., Jacobs, J. P., Justo, R., Latal, B., Li, J. S., Mahle, W. T., McQuillen, P. S., Menon, S. C., Pemberton, V. L., Pike, N. A., Pizarro, C., Shekerdemian, L. S., Synnes, A., Williams, I., Bellinger, D. C., & Newburger, J. W.
- ORCID
- Gaynor, J. William
- Stopp, Christian
- Wypij, David
- Andropoulos, Dean B.
- Atallah, Joseph
- Atz, Andrew M.
- Donofrio, Mary T.
- Goldberg, Caren S.
- Hövels-Gürich, Hedwig
- Ichida, Fukiko
- Jacobs, Jeffrey P.
- Justo, Robert
- Latal, Beatrice
- Li, Jennifer S.
- Mahle, William T.
- McQuillen, Patrick S.
- Menon, Shaji C.
- Pemberton, Victoria L.
- Pike, Nancy A.
- Pizarro, Christian
- Shekerdemian, Lara S.
- Synnes, Anne
- Newburger, Jane W.
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2016-09
- Volume
- 102
- Issue
- 3
- Pages
- 843-849
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W2509335843
- Cited by
- 152
- References
- 18
- Citations by year
- 2026: 13 · 2025: 11 · 2024: 17 · 2023: 16 · 2022: 22 · 2021: 8 · 2020: 12 · 2019: 22 · 2018: 15 · 2017: 14 · 2016: 2
- FWCI
- 16.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- RWTH Publications (RWTH Aachen) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U54HD090255)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
- Keywords
- neurodevelopmental outcomes, congenital heart disease, cardiopulmonary bypass, infants, psychomotor development, cognitive development, extracorporeal membrane oxygenation, ventricular assist devices, postoperative hospital stay, Bayley Scales of Infant Development, developmental disabilities
- MeSH terms
- Brain, Cardiopulmonary Bypass, Child Development, Child, Preschool, Female, Heart Defects, Congenital, Cardiac Surgical Procedures, Humans, Infant, Male
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