Related Experiment Video
Updated: Jun 27, 2026
Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest
Published on: May 26, 2023
Inflammatory response and neurodevelopmental outcome after open-heart surgery in children
Peter Gessler1, Bernhard Schmitt, Rene Prètre
1Division of Pediatric Intensive Care Medicine, University Children's Hospital of Zurich, Zurich, Switzerland. peter.gessler@klinikum-konstanz.de
Insights
Children undergoing heart surgery often experience neurodevelopmental issues. Preexisting impairments predict outcomes, while inflammatory markers do not directly influence IQ, though IL-6 may affect neuromotor function.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Science
- Inflammatory Response
Background:
- Children undergoing open-heart surgery with cardiopulmonary bypass (CPB) frequently exhibit long-term neurodevelopmental deficits.
- The relationship between postoperative inflammatory responses and neurodevelopmental outcomes in these children requires further investigation.
Purpose of the Study:
- To determine the neurodevelopmental outcome in children following open-heart surgery.
- To assess the influence of postoperative inflammatory reactions on neurodevelopmental outcomes.
Main Methods:
- Prospective observational study of 32 children with congenital heart defects undergoing elective open-heart surgery.
- Neurodevelopmental assessment at a median of 6 months post-CPB, with preoperative assessments for 14 children.
- Measurement of plasma inflammatory markers (IL-6, IL-8, C-reactive protein) and neutrophils post-CPB.
Main Results:
- Preoperative intellectual performance strongly predicted postoperative IQ scores (R² = 83.8%, p < 0.0001).
- Inflammatory variables were not significant predictors of postoperative IQ.
- Neuromotor abnormalities were associated with cyanotic heart defects, CPB duration, aortic clamp time, and early IL-6 levels (R² = 67.8%, p = 0.002).
Conclusions:
- Preexisting neurodevelopmental impairment is common and predicts postoperative outcomes in children after heart surgery.
- Postoperative neuromotor disabilities are linked to the type of congenital heart defect, surgical procedure, and CPB complications, with IL-6 playing a role.
Abstract:
Long-term neurodevelopmental sequelae are commonly detectable in children after open-heart surgery with cardiopulmonary bypass (CPB). The objective of the study was to determine the neurodevelopmental outcome in these children in relation to postoperative inflammatory reaction. This is a prospective, observational study on children with congenital heart defects (n = 32) undergoing elective open-heart surgery in a tertiary pediatric cardiac center. Neurodevelopmental outcome was assessed in the median 6 months after CPB. Neurological examination was done in all children before the operation and, additionally, complete neurodevelopmental status was assessed preoperatively in 14 children. Three hours after the end of CPB, plasma concentrations of interleukin (IL)-6 and IL-8 were strongly elevated (p < 0.001). Moreover, there was a rise of neutrophils and C-reactive protein at 24 h postoperatively (p < 0.001). Intellectual performance after surgery was correlated with preoperative performance, r ( S ) = 0.83, p < 0.001 (mean IQ scores after CPB = 90.4 +/- 18.4 and before CPB = 87.5 +/- 14.5, p = 0.20). Multiple regression analysis demonstrated that preoperative IQ scores accounted for 83.8% of the variance of postoperative IQ scores (p < 0.0001). Inflammatory variables were not significant predictors of postoperative IQ scores. The frequency of neuromotor abnormalities at 6 months after CPB was influenced by the presence of a cyanotic heart defect, duration of CPB and aortic clamp time, and plasma levels of IL-6 shortly after CPB (R (2) = 67.8%, p = 0.002). In conclusion, in the examined population, preexisting neurodevelopmental impairment is frequent and predicts postoperative outcome. The high frequency of postoperative neuromotor disabilities seems to be associated with the type of congenital heart defect but also with the procedure and possible complications of CPB.