Patterns of developmental dysfunction after surgery during infancy to correct transposition of the great arteries

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Implantation of Total Artificial Heart in Congenital Heart Disease
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D C Bellinger1, L A Rappaport, D Wypij

  • 1Department of Neurology, Children's Hospital, Boston MA 02115, USA.

Journal of Developmental and Behavioral Pediatrics : JDBP
|April 1, 1997
PubMed

Insights

Total circulatory arrest during heart surgery for d-transposition of the great arteries may increase risks for early developmental delays in children, impacting motor and language functions.

Area of Science:

  • Pediatric Cardiology
  • Developmental Pediatrics
  • Pediatric Cardiac Surgery

Background:

  • d-Transposition of the great arteries (dTGA) is a critical congenital heart defect requiring surgical repair.
  • Arterial switch operation (ASO) is a common surgical repair for dTGA.
  • Cardiopulmonary bypass techniques, including total circulatory arrest (TCA) and low-flow cardiopulmonary bypass (LF-CPB), are used during ASO.

Purpose of the Study:

  • To compare the early neurodevelopmental outcomes of infants with dTGA undergoing ASO using predominantly TCA versus predominantly LF-CPB.

Main Methods:

  • A randomized clinical trial involving 171 infants with dTGA undergoing ASO.
  • Comparison of developmental assessments at 1 year of age using Bayley Scales of Infant Development.
  • Parental questionnaires at 2.5 years of age to assess behavioral and language development.

Main Results:

  • Children in the TCA group scored lower on the Bayley Scales of Infant Development at 1 year of age compared to the LF-CPB group.
  • At 2.5 years, children in the TCA group exhibited poorer expressive language and increased behavioral problems (internalizing and externalizing).
  • The increased risk was more pronounced in children with a ventricular septal defect.

Conclusions:

  • The use of TCA during ASO for dTGA may be associated with increased risks of early developmental difficulties.
  • Developmental domains affected include motor and language function, as well as behavioral outcomes.
  • LF-CPB may be a safer alternative regarding early neurodevelopmental outcomes in this pediatric population.

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