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Long-term neurodevelopmental outcome and exercise capacity after corrective surgery for tetralogy of Fallot or
Hedwig H Hövels-Gürich1, Kerstin Konrad, Daniela Skorzenski
1Department of Pediatric Cardiology, Aachen University of Technology, Aachen, Germany. hhoevels-guerich@ukaachen.de
Insights
Children undergoing corrective surgery for heart defects in infancy show reduced neurodevelopmental outcomes, particularly motor skills, but maintain normal exercise capacity. Socioeconomic status significantly impacts cognitive development post-surgery.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Surgical Outcomes
Background:
- Tetralogy of Fallot (TOF) and Ventricular Septal Defect (VSD) are congenital heart defects requiring surgical correction.
- Early surgical intervention aims to improve long-term health and development.
- Long-term neurodevelopmental and functional outcomes after infant cardiac surgery require continued investigation.
Purpose of the Study:
- To compare neurodevelopmental status and exercise capacity in children 5-10 years post-correction for TOF or VSD with controls.
- To determine if preoperative hypoxemia (TOF) or cardiac insufficiency (VSD) influences these outcomes.
- To assess the impact of surgical management on long-term neurodevelopment and function.
Main Methods:
- Prospective study of 40 children (20 TOF, 20 VSD) operated on in infancy (mean age 0.7 years).
- Comprehensive neurodevelopmental and exercise capacity assessments at a mean age of 7.4 years.
- Comparison with normal children and correlation with preoperative, perioperative, and postoperative factors.
Main Results:
- Children exhibited reduced motor function, intelligence, academic achievement, and language compared to controls (p < 0.01 to p < 0.001).
- Motor dysfunction was higher in TOF patients and correlated with poorer neurodevelopmental outcomes.
- Exercise capacity and socioeconomic status were comparable to controls, though socioeconomic status impacted cognitive scores.
Conclusions:
- Infant corrective surgery for TOF/VSD is linked to reduced neurodevelopmental outcomes, especially motor skills in hypoxemic TOF patients.
- Exercise capacity is generally preserved, but cognitive development is influenced by socioeconomic factors.
- Perioperative management plays a critical role in long-term neurodevelopmental impairment risk.
Background:
The purpose of this prospective study was to assess whether neurodevelopmental status and exercise capacity of children 5 to 10 years after corrective surgery for tetralogy of Fallot or ventricular septal defect in infancy was different compared with normal children and influenced by the preoperative condition of hypoxemia or cardiac insufficiency.
Methods:
Forty unselected children, 20 with tetralogy of Fallot and hypoxemia and 20 with ventricular septal defect and cardiac insufficiency, operated on with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass at a mean age of 0.7 +/- 0.3 years (mean +/- SD), underwent, at mean age 7.4 +/- 1.6 years, standardized evaluation of neurologic status, gross motor function, intelligence, academic achievement, language, and exercise capacity. Results were compared between the groups and related to preoperative, perioperative, and postoperative status and management.
Results:
Rate of mild neurologic dysfunction was increased compared with normal children, but not different between the groups. Exercise capacity and socioeconomic status were not different compared with normal children and between the groups. Compared with the normal population, motor function, formal intelligence, academic achievement, and expressive and receptive language were significantly reduced (p < 0.01 to p < 0.001) in the whole group and in the subgroups, except for normal intelligence in ventricular septal defect patients. Motor dysfunction was significantly higher in the Fallot group compared with the ventricular septal defect group (p < 0.01) and correlated with neurologic dysfunction, lower intelligence, and reduced expressive language (p < 0.05 each). Reduced New York Heart Association functional class was correlated with lower exercise capacity and longer duration of cardiopulmonary bypass (p < 0.05 each). Reduced socioeconomic status significantly influenced dysfunction in formal intelligence (p < 0.01) and academic achievement (p < 0.05). Preoperative risk factors such as prenatal hypoxia, perinatal asphyxia, and preterm birth, factors of perioperative management such as cardiac arrest, lowest nasopharyngeal temperature, and age at surgery, and postoperative risk factors as postoperative cardiocirculatory insufficiency and duration of mechanical ventilation were not different between the groups and had no influence on outcome. Degree of hypoxemia in Fallot patients and degree of cardiac insufficiency in ventricular septal defect patients did not influence the outcome within the subgroups.
Conclusions:
Children with preoperative hypoxemia in infancy are at higher risk for motor dysfunction than children with cardiac insufficiency. Corrective surgery in infancy for tetralogy of Fallot or ventricular septal defect with combined circulatory arrest and low flow bypass is associated with reduced neurodevelopmental outcome, but not with reduced exercise capacity in childhood. In our experience, the general risk of long-term neurodevelopmental impairment is related to unfavorable effects of the global perioperative management. Socioeconomic status influences cognitive capabilities.
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