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Published on: May 26, 2023
Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations
Insights
Postoperative events, not operative factors, significantly impact neurodevelopmental outcomes in infants after heart surgery. Early outcomes improved over time, emphasizing the need to address patient and postoperative variables for better results.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Outcomes
- Congenital Heart Disease Surgery
Background:
- Neurodevelopmental disability is a significant concern following surgical repair of congenital heart defects.
- Previous research identified patient, preoperative factors, center, and birth year as limited predictors of neurodevelopmental outcomes (Psychomotor Development Index [PDI] and Mental Development Index [MDI]).
- This study aimed to quantify the additional variance in PDI and MDI explained by operative variables and postoperative events.
Purpose of the Study:
- To determine the contribution of intraoperative and postoperative factors to neurodevelopmental outcomes in infants undergoing cardiac surgery.
- To identify specific operative and postoperative variables associated with neurodevelopmental deficits.
Main Methods:
- Analysis of 1,770 infants undergoing operations with cardiopulmonary bypass before 9 months of age (1996-2009).
- Linear regression models were used to assess the impact of operative factors (e.g., support time) and postoperative events (e.g., extracorporeal membrane oxygenation, length of stay) on PDI and MDI.
- Adjustments were made for patient, preoperative, center, and birth year variables.
Main Results:
- Longer cardiopulmonary bypass support time correlated with lower PDI and MDI.
- Extracorporeal membrane oxygenation or ventricular assist device support and longer postoperative length of stay were associated with lower PDI and MDI.
- Intraoperative and postoperative factors accounted for an additional 5% of the variance in PDI and MDI, with longer support time not being a significant predictor in the final models.
Conclusions:
- Postoperative events and innate patient/preoperative factors appear more critical than operative factors in predicting early neurodevelopmental outcomes after infant cardiac surgery.
- Neurodevelopmental outcomes demonstrated improvement over calendar time when adjusted for patient and medical variables.
Background:
Neurodevelopmental disability is common after operations for congenital heart defects. We previously showed that patient and preoperative factors, center, and calendar year of birth explained less than 30% of the variance for the Psychomotor Development Index (PDI) and the Mental Development Index (MDI) of the Bayley Scales of Infant Development-Second Edition. Here we investigate how much additional variance in PDI and MDI is contributed by operative variables and postoperative events.
Methods:
We analyzed neurodevelopmental outcomes after operations with cardiopulmonary bypass at age 9 months or younger between 1996 and 2009. We used linear regression to investigate the effect of operative factors (age, weight, and cardiopulmonary bypass variables) and postoperative events on neurodevelopmental outcomes, adjusting for center, type of congenital heart defect, year of birth, and preoperative factors.
Results:
We analyzed 1,770 children from 22 institutions with neurodevelopmental testing at age 13.3 months (range, 6 to 30 months). Among operative factors, longer total support time was associated with lower PDI and MDI (p < 0.05). When postoperative events were added, use of either extracorporeal membrane oxygenation or ventricular assist device support, and longer postoperative length of stay were associated with lower PDI and MDI (p < 0.05). Longer total support time was not a significant predictor in these models. After adjusting for patient, preoperative, intraoperative, and postoperative factors, measured intraoperative and postoperative factors accounted for 5% of the variances in PDI and MDI.
Conclusions:
Operative factors may be less important than innate patient and preoperative factors and postoperative events in predicting early neurodevelopmental outcomes after cardiac operations in infants. Neurodevelopmental outcomes improved over calendar time when adjusted for patient and medical variables.
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