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Outcome after open-heart surgery in infants and children
G Miller1, J R Tesman, J C Ramer
1Section of Child Neurology, Baylor College of Medicine, Houston, TX, 77030, U
Insights
Children undergoing open-heart surgery may face neurodevelopmental challenges. Longer deep hypothermia and certain heart conditions, especially in neonates, are linked to poorer outcomes like lower IQ and cerebral palsy.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Outcomes
- Pediatric Cardiac Surgery
Background:
- Open-heart surgery in children is a critical intervention.
- Assessing long-term neurodevelopmental outcomes is essential for patient care.
- Previous studies have indicated potential risks associated with pediatric cardiac surgery.
Purpose of the Study:
- To evaluate the neurodevelopmental outcomes of children following open-heart surgery.
- To identify factors associated with adverse neurodevelopmental outcomes.
- To understand the impact of surgical variables on long-term neurological and cognitive function.
Main Methods:
- A cohort of 104 unselected children undergoing open-heart surgery between 1987-1989 were studied.
- Survivors received formal neurological and psychometric examinations after 2 years of age.
- Data on patient age at operation, type of cardiac lesion, and duration of deep hypothermia were collected.
Main Results:
- Mean IQ was 90, with 78% scoring above 70; 22% developed cerebral palsy.
- Deep hypothermia >45 minutes correlated with IQ <85 (P < .001) and cerebral palsy (P = .02).
- Infants <1 month old had a median IQ of 96 and 25% cerebral palsy; hypoplastic left heart syndrome survivors had a median IQ of 66 and 57% cerebral palsy.
Conclusions:
- While most children have good outcomes, significant neurodevelopmental morbidity exists after open-heart surgery.
- Factors like lesion type and duration of hypothermia, especially in neonates, significantly impact outcomes.
- Age at operation and specific congenital heart defects are critical determinants of neurodevelopmental prognosis.
Abstract:
We have studied the neurodevelopmental outcome of 104 consecutive unselected children who underwent open-heart surgery from 1987 through 1989. Survivors had formal neurologic and psychometric examinations after 2 years of age. Mean IQ was 90, and 78% had scores above 70. Cerebral palsy occurred in 22%. Deep hypothermia for longer than 45 minutes was associated with IQ less than 85 (P < .001) and later cerebral palsy (P = .02). Those less than 1 month old at operation had a median IQ of 96, and 25% had cerebral palsy. Median IQ for survivors of hypoplastic left heart syndrome was 66, only one had an IQ above 70, and 57% had cerebral palsy. Median IQ for transposition of great arteries was 109, only one was less than 85, and all had normal neurologic examinations. Those between 1 and 6 months of age at operation had a median IQ of 93, with 64% above 85, and 5% had cerebral palsy. Those older than 6 months had a median IQ of 99, with 70% above 85, and 13% had cerebral palsy. For infants less than 1 month old at operation, a strong association existed between outcome, type of lesion, and duration of deep hypothermia (P < .01), although not in all cases. In those older than 1 month at operation, no association existed between outcome and any study variable. Although the majority of children have an uneventful outcome after open-heart surgery, a significant morbidity exists. This is related to several factors, including type of lesion and duration of hypothermia, particularly in neonates; preoperative congenital and acquired lesions; and possible perioperative cerebrovascular events.