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Patterns of developmental dysfunction after surgery during infancy to correct transposition of the great arteries
D C Bellinger1, L A Rappaport, D Wypij
1Department of Neurology, Children's Hospital, Boston MA 02115, USA.
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.
Abstract:
A randomized clinical trial was conducted to compare the early development of children with d-transposition of the great arteries (N = 171) repaired by an arterial switch operation that used either predominantly total circulatory arrest or predominantly continuous low-flow cardiopulmonary bypass. The children assigned to the circulatory arrest group scored lower than those assigned to low-flow bypass on the Bayley Scales of Infant Development at 1 year of age. Responses to parental questionnaires completed when the children were 2.5 years old indicated that the children in the circulatory arrest group, especially those with a ventricular septal defect, also manifested poorer expressive language and were considered to display more internalizing and externalizing problem behaviors. The use of circulatory arrest to protect vital organs during open heart surgery might place children at increased risk of early developmental difficulties, especially in the domains of motor and language function.