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Published on: May 26, 2023
Neurodevelopmental outcomes after biventricular repair of congenital heart defects
Joseph M Forbess1, Karen J Visconti, David C Bellinger
1Departments of Cardiovascular Surgery and Neuroepidemiology, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA. forbess@cardio.tch.harvard.edu
Insights
Children undergoing biventricular repair for congenital heart defects generally have normal IQs. However, prolonged hypothermic circulatory arrest (over 39 minutes) may be linked to deficits in visual-motor and fine motor skills.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Congenital Heart Disease
Background:
- Biventricular repair is a common surgical intervention for congenital heart defects (CHDs).
- Neurodevelopmental outcomes following CHD repair are a significant concern for long-term patient well-being.
Purpose of the Study:
- To assess the neurodevelopmental outcomes, specifically cognitive and visual-motor skills, in children at 5 years of age after undergoing biventricular repair for CHDs.
- To identify potential predictors of neurodevelopmental outcomes, including age at repair, duration of hypothermic circulatory arrest, parental IQ, and socioeconomic status.
Main Methods:
- Sixty-nine children who had biventricular repair were evaluated at 5 years of age using the Wechsler Preschool and Primary Scales of Intelligence-Revised (WPPSI-R) for IQ assessment and the Wide Range Assessment of Visual-Motor Abilities (WRAVMA) for visual-motor skills.
- Regression analyses were performed, adjusting for parental IQ and socioeconomic status, to determine factors influencing cognitive and visual-motor outcomes.
Main Results:
- Overall, mean full-scale, performance, and verbal IQ scores for the study population were within the average range.
- Anatomic diagnosis, age at operation, and the use of hypothermic circulatory arrest (HCA) did not significantly impact overall IQ scores.
- However, HCA exceeding 39 minutes was associated with lower scores in visual-motor and fine motor abilities, and potentially lower full-scale IQ, particularly after adjusting for socioeconomic status.
Conclusions:
- Children who have undergone biventricular repair for CHDs typically exhibit neurodevelopmental outcomes within the normal range.
- Prolonged durations of hypothermic circulatory arrest (greater than 39 minutes) during surgery may be associated with specific neurodevelopmental deficits, particularly in visual-motor and fine motor domains.
Objective:
This study was undertaken to assess neurodevelopment of children after biventricular repair of congenital heart defects.
Methods:
Full-scale, performance, and verbal IQs of 69 patients who had undergone biventricular repair were assessed at 5 years of age with the Wechsler Preschool and Primary Scales of Intelligence-Revised. The Wide Range Assessment of Visual-Motor Abilities was used to measure visual-motor skills. Regression analyses adjusting for parental IQ and socioeconomic status were used to evaluate outcome predictors.
Results:
Median age at repair was 91 days (range 1-1558 days). Hypothermic circulatory arrest was used in 35 cases (mean duration of hypothermic circulatory arrest 33 +/- 17 minutes). Mean full-scale, performance, and verbal IQs for the entire study population were within the reference range (full-scale 96.9 +/- 15.9, performance 96.6 +/- 16.8, verbal 97.7 +/- 15.2). Anatomic diagnosis, age at operation, and use of hypothermic circulatory arrest did not influence full-scale IQ (P =.66, P =.14, and P =.46, respectively), performance IQ (P =.64, P =.36, and P =.73, respectively), or verbal IQ (P =.74, P =.08, and P =.39, respectively). Among patients subjected to hypothermic circulatory arrest, duration of arrest was evaluated as a predictor of outcome. After adjustment for parental IQ, full-scale (P =.12), performance (P =.07), and verbal (P =.22) IQ scores of patients with more than 39 minutes of hypothermic circulatory arrest were not different from those of patients who had arrest periods of 39 minutes or less. After adjustment for socioeconomic status, however, full-scale (P =.05) and performance (P =.03) IQ scores were lower among patients who had more than 39 minutes of hypothermic circulatory arrest. After adjustment for either parental IQ or socioeconomic status, patients with more than 39 minutes of arrest had lower scores on Wide Range Assessment of Visual-Motor Abilities subtests of visual-motor and fine motor abilities and on several performance IQ subtests.
Conclusions:
IQs of patients who had undergone biventricular repair of congenital heart defects were within the reference range. However, hypothermic circulatory arrest for longer than 39 minutes was associated with deficits in visual-motor and fine motor skills and possibly in full-scale IQ.
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