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Neurodevelopmental outcomes after congenital heart surgery and strategies for improvement

Sarah Tabbutt1, J William Gaynor, Jane W Newburger

  • 1University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA. tabbutts@peds.ucsf.edu

Current Opinion in Cardiology
|January 26, 2012
PubMed

Insights

Neonatal heart surgery for complex congenital heart lesions may impact neurodevelopmental outcomes. Research indicates patient and socioeconomic factors are primary risks, with few modifiable variables influencing infant brain development.

Area of Science:

  • Pediatric Cardiology
  • Neurodevelopmental Pediatrics
  • Congenital Heart Disease Research

Background:

  • Neonatal and infant heart surgery for complex congenital heart lesions is a critical intervention.
  • Pre-existing brain immaturity is often observed in newborns with these conditions.

Purpose of the Study:

  • To review neurodevelopmental and neuropsychologic outcomes after neonatal and infant heart surgery for complex congenital heart lesions.
  • To analyze recent data on perioperative magnetic resonance imaging (MRI) and randomized clinical trials (RCTs) concerning perioperative variables.

Main Methods:

  • Review of recent reports on perioperative MRI.
  • Analysis of recent randomized clinical trials addressing perioperative variables.
  • Exploration of robust analyses from clinical, cross-sectional, and prospective trials.

Main Results:

  • Advancements in MRI confirm newborns with complex congenital heart lesions often have brain immaturity.
  • RCTs found no significant difference in 1-year outcomes between regional cerebral perfusion and deep hypothermic circulatory arrest.
  • No significant differences in outcomes were found for different shunt types in the Norwood procedure or for cardiopulmonary bypass methods in arterial switch operations.

Conclusions:

  • Most identified risk factors for worsened neurodevelopmental outcomes are patient-related or socioeconomic.
  • Few risk factors influencing neurodevelopmental outcomes are potentially modifiable.
  • Further research is needed to identify and address modifiable risk factors.
Abstract

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