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Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: The Boston Circulatory Arrest Trial
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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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“Thus, the interplay between disease complexity and neurodevelopment is also present in TOF, similarly to patients with other severe CHDs, including single ventricle heart disease and transposition of the great arteries [5, 7, 21].”
From Early Evaluation and the Effect of Socioeconomic Factors on Neurodevelopment in Infants with Tetralogy of Fallot. (2021) · cites this paper as [5]
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Metadata
- Authors
- Bellinger, D. C., Wypij, D., duPlessis, A. J., Rappaport, L. A., Jonas, R. A., Wernovsky, G., & Newburger, J. W.
- Affiliations
- Boston Children's Hospital (US)
- Corresponding author
- Bellinger, David C
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2003-11
- Volume
- 126
- Issue
- 5
- Pages
- 1385-1396
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2087859772
- Cited by
- 681
- References
- 65
- Citations by year
- 2026: 24 · 2025: 26 · 2024: 20 · 2023: 23 · 2022: 27 · 2021: 30 · 2020: 38 · 2019: 32 · 2018: 26 · 2017: 26 · 2016: 30 · 2015: 21 · 2014: 26 · 2013: 32 · 2012: 34
- FWCI
- 19.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01hl041786-13)
- National Heart, Lung, and Blood Institute (HL 41786)
- National Center for Research Resources (M01RR002172, RR02172)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (P30HD018655, P30HD-18655)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Cardiovascular Conditions and Treatments
- Keywords
- dextro-transposition of the great arteries, neurodevelopmental outcomes, total circulatory arrest, low-flow cardiopulmonary bypass, arterial switch operation, infant cardiac surgery, apraxia of speech, fine motor function, sustained attention, academic performance
- MeSH terms
- Boston, Cardiopulmonary Bypass, Child, Developmental Disabilities, Female, Follow-Up Studies, Heart Arrest, Induced, Cardiac Surgical Procedures, Humans, Infant, Newborn, Intelligence Tests, Male, Nervous System Diseases, Neurologic Examination, Neuropsychological Tests, Probability, Prospective Studies, Reference Values, Severity of Illness Index, Transposition of Great Vessels, Treatment Outcome, Risk Assessment, Motor Skills Disorders
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