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Published on: March 4, 2022
New approaches to neuroprotection in infant heart surgery
Erin L Albers1, David P Bichell, Bethann McLaughlin
1Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee 37323, USA.
Insights
Children with congenital heart disease (CHD) often experience neurodevelopmental deficits after surgery. New research explores neuroprotective strategies to improve brain health in these young patients.
Area of Science:
- Pediatric Cardiology
- Neuroscience
- Surgical Outcomes
Background:
- Congenital heart disease (CHD) surgical repair has improved survival rates.
- A significant percentage of CHD survivors experience neurodevelopmental deficits by school age.
- Current intraoperative modifications have not improved long-term neurologic outcomes.
Observation:
- Mechanisms of cellular injury and endogenous protection in CHD are increasingly understood.
- This provides potential targets for preventing and treating neurologic injury.
- Multisystem approaches, like ischemic preconditioning, are being investigated.
Findings:
- Neurodevelopmental outcomes remain a significant challenge in CHD survivors.
- Understanding cellular injury mechanisms offers new therapeutic avenues.
- Multisystem neuroprotection strategies show promise.
Implications:
- Developing effective neuroprotective strategies for pediatric CHD is crucial.
- New diagnostic tools and therapies are needed to limit neurologic injury.
- Improving neurodevelopmental outcomes will enhance long-term quality of life for CHD patients.
Abstract:
Advances in surgical techniques and perioperative management have led to dramatic improvements in outcomes for children with complex congenital heart disease (CHD). As the number of survivors continues to grow, clinicians are becoming increasingly aware that adverse neurodevelopmental outcomes after surgical repair of CHD represent a significant cause of morbidity, with widespread neuropsychologic deficits in as many as 50% of these children by the time they reach school age. Modifications of intraoperative management have yet to measurably impact long-term neurologic outcomes. However, exciting advances in our understanding of the underlying mechanisms of cellular injury and of the events that mediate endogenous cellular protection have provided a variety of new potential targets for the assessment, prevention, and treatment of neurologic injury in patients with CHD. In this review, we will discuss the unique challenges to developing neuroprotective strategies in children with CHD and consider how multisystem approaches to neuroprotection, such as ischemic preconditioning, will be the focus of ongoing efforts to develop new diagnostic tools and therapies. Although significant challenges remain, tremendous opportunity exists for the development of diagnostic and therapeutic interventions that can serve to limit neurologic injury and ultimately improve outcomes for infants and children with CHD.
