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Transient Middle Cerebral Artery Occlusion Model of Neonatal Stroke in P10 Rats
Published on: April 21, 2017
Intermediate-term neurodevelopmental outcomes and quality of life after arterial switch operation beyond early
Sowmya Ramanan1, Soumya Sundaram2, Arun Gopalakrishnan3
1Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
Insights
Children undergoing arterial switch operation (ASO) show good cardiac health and quality of life. However, neurodevelopmental disorders (NDD) affect one-fourth of patients, linked to delayed lactate normalization and socioeconomic factors.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Health-Related Quality of Life Research
Background:
- The arterial switch operation (ASO) is a critical procedure for congenital heart defects.
- Long-term outcomes beyond cardiac function, including neurodevelopment and quality of life, require thorough evaluation.
Purpose of the Study:
- To assess cardiac, neurodevelopmental, psycho-social, and health-related quality of life (HRQOL) outcomes in children post-ASO.
- To identify factors influencing these outcomes, including socioeconomic status and perioperative variables.
Main Methods:
- A cohort of children who underwent ASO were followed for 3-5 years.
- Assessments included cardiovascular evaluations, validated neurodevelopmental tools, and HRQOL questionnaires.
- Neurodevelopmental disorder (NDD) was defined by specific developmental, behavioral, and neurological criteria.
Main Results:
- Of 61 survivors, 31.1% had neurological abnormalities, with 27.9% diagnosed with NDD.
- Health-related quality of life scores were generally high (>90).
- Multivariate analysis linked longer time to lactate normalization and lower socioeconomic status with developmental delay.
Conclusions:
- Intermediate-term cardiac outcomes and HRQOL following ASO are generally favorable.
- Neurodevelopmental disorders are prevalent in approximately one-fourth of children after ASO.
- Delayed lactate normalization and lower socioeconomic status are associated with poorer neurodevelopmental outcomes post-ASO.
Objectives:
The study objective was to evaluate the cardiac, neurodevelopmental, psycho-social and health-related quality of life (HRQOL) outcomes of children who underwent an arterial switch operation (ASO).
Methods:
Children who underwent ASO were evaluated on follow-up at 3-5 years with cardiovascular, neurodevelopmental and HRQOL assessment using validated tools. Children with developmental delay, attention-deficit hyperactivity disorder, autism spectrum disorder, neuromotor and speech and language impairment were considered to have neurodevelopmental disorder (NDD). The impact of socioeconomic status (Kuppuswamy classification), perioperative cardiac, nutritional and psycho-social factors on outcomes was analysed.
Results:
There were 61 (89.7%) survivors at a mean follow-up of 50.9 ± 7.6 months. The median age at surgery was 41 days (22-74.5). One-third of patients had growth restriction. Two children had residual cardiovascular lesions requiring intervention. The mean HRQOL score was >90 in all scales of the Paediatric Quality of Life Inventory™ 3.0 Cardiac Module. Neurological abnormalities were seen in 19 patients (31.1%) of whom 17 (27.9%) patients had NDD and 12 had developmental delay. Speech and language impairment, attention-deficit hyperactivity disorder, and neuromotor impairment were found in 16.4%, 3.3% and 6.7% patients, respectively. On multivariate analysis, increasing time to lactate normalization and low socioeconomic status were associated with developmental delay after ASO.
Conclusions:
While intermediate-term cardiac outcomes and HRQOL after ASO were fairly satisfactory, NDD was identified in one-fourth of these children. Increasing time to lactate normalization after ASO and low socioeconomic status were associated with suboptimal intermediate neurodevelopment outcomes after ASO.
