Risk factors for neurodevelopmental impairments in school-age children after cardiac surgery with full-flow cardiopulmonary bypass

详细信息    查看全文

• 作者：Michael von Rhein ; MD^a ; ^b ; ^{Michael.vonrhein@kispi.uzh.ch} ; Anastasia Dimitropoulos ; MD^a ; Emanuela R. Valsangiacomo Buechel ; MD^c ; Markus A. Landolt ; PhD^d ; Beatrice Latal ; MD ; MPH^a ; ^e
• 关键词：19 ; 20
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2012
• 出版时间：September, 2012
• 年：2012
• 卷：144
• 期：3
• 页码：577-583
• 全文大小：139 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferences

Objective

To determine the risk factors for adverse neurodevelopmental outcomes in school-age children after full flow open-heart surgery for congenital heart disease.

Methods

The outcome was assessed in 117 children without a genetic comorbidity at a mean age of 10.4 ¡À 2.5 years. Intelligence was assessed using the Raven's Progressive Matrices and neuromotor function using the Zurich Neuromotor Assessment. Risk factors were retrieved from detailed chart review.

Results

The mean intelligence score was 89 ¡À 16, significantly lower than the norm (P?<?.001). Cerebral palsy was diagnosed in 10 % of patients. Poor neuromotor performance (less than p10) was present in 15 % to 20 % of the children, depending on the motor task (all P?<?.001). Pure motor and static balance performance was also significantly impaired when patients with cerebral palsy were excluded (P?<?.01). Intelligence was only related to socioeconomic status (P?=?.006), and neuromotor outcome was related to the length of hospital stay and postoperative neurologic abnormalities (P?<?.03). The extracorporeal circulation time was related to adaptive fine motor performance (P?=?.05). All other variables were not related to outcome.

Conclusions

Children without a genetic comorbidity are at risk of long-term intellectual and motor impairments also after full-flow cardiac repair. Surgery-related parameters play a less important role for adverse outcomes than postoperative complications. Our findings stress the importance of specialized follow-up assessments for all children with CHD undergoing open heart surgery.