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Vol.3 - No.1

Deep Hypothermic circulatory arrest does not impair neurodevelopmental outcome in school-age children after infant cardiac surgery

By : baghaei

Keywords : -

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Background: The purpose of this study was to assess deep
hypothermic circulatory arrest (DHCA) as a modifier of
neurodevelopmental (ND) outcomes in preschool children
after cardiac surgery in infancy for repair of congenital
heart defects (CHD).

Methods

Methods: This is a planned analysis of infants enrolled in a
prospective study of apolipoprotein E polymorphisms and
ND outcome after cardiac surgery. The effect of DHCA
was assessed in patients with single or biventricular CHD
without aortic arch obstruction. Neurodevelopmental as-
sessment at 4 years of age included cognition, language, at-
tention, impulsivity, executive function, social competence,
and visual-motor and fine-motor skills. Patient and proce-
dural variables were evaluated in univariate and multivari-
ate models.

Results

Results: Neurodevelopmental testing was completed in 238
of 307 eligible patients (78%). Deep hypothermic circula-
tory arrest was used at the discretion of the surgeon at leastonce in 92 infants (38.6%) with a median cumulative dura-
tion of 36 minutes (range, 1 to 132 minutes). By univariate
analysis, DHCA patients were more likely to have single-
ventricle CHD (p = 0.013), lower socioeconomic status (p
< 0.001), a higher incidence of preoperative ventilation (p
< 0.001), and were younger and smaller at the first surgery
(p < 0.001). By multivariate analysis, use of DHCA was not
predictive of worse performance for any ND outcome.

Conclusion

Conclusions: In this cohort of children undergoing repair of
CHD in infancy, patients who underwent DHCA had risk
factors associated with worse ND outcomes. Despite these,
use of DHCA for repair of single-ventricle and biventricu-
lar CHD without aortic arch obstruction was not predictive
of worse performance for any ND domain tested at 4 years
of age.

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