Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations

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• 作者：The International Cardiac Collaborative on Neurodevelopment (ICCON) Investigatorsp>&lowast ; p> ; J. William Gaynor ; MD ; Christian Stopp ; MS ; David Wypij ; PhD ; Dean B. Andropoulos ; MD ; Joseph Atallah ; MD ; FRCPC ; Andrew M. Atz ; MD ; John Beca ; MD ; Mary T. Donofrio ; MD ; Kim Duncan ; MD ; Nancy S. Ghanayem ; MD ; Caren S. Goldberg ; MD ; Hedwig Hö ; vels-Gü ; rich ; MD ; Fukiko Ichida ; MD ; Jeffrey P. Jacobs ; MD ; Robert Justo ; MD ; Beatrice Latal ; MD ; Jennifer S. Li ; MD ; William T. Mahle ; MD ; Patrick S. McQuillen ; MD ; Shaji C. Menon ; MD ; Victoria L. Pemberton ; RNC ; MS ; Nancy A. Pike ; RN ; PhD ; Christian Pizarro ; MD ; Lara S. Shekerdemian ; MD ; Anne Synnes ; MDCM ; Ismee Williams ; MD ; David C. Bellinger ; PhD ; MS ; Jane W. Newburger ; MD ; MPH
• 关键词：BSID-II ; Bayley Scales of Infant Development ; Second Edition ; CHD ; congenital heart disease ; CI ; confidence interval ; CPB ; cardiopulmonary bypass ; CPR ; cardiopulmonary resuscitation ; DHCA ; deep hypothermic circulatory arrest ; ECMO ; extracorporeal membrane oxygenation ; HLHS ; hypoplastic left heart syndrome ; LOS ; length of stay ; MDI ; Mental Development Index ; ND ; neurodevelopmental ; PDI ; Psychomotor Development Index ; RCP ; regional cerebral perfusion ; TGA ; dextro-transposition of the great arterie
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：102
• 期：3
• 页码：843-849
• 全文大小：280 K

文摘

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.p>

Methods

<p id="abspara0015">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.p>

Results

<p id="abspara0020">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.p>

Conclusions

<p id="abspara0025">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.