The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 4 , Pages 924-932, October 2009

Two-year neurodevelopmental outcomes of infants undergoing neonatal cardiac surgery for interrupted aortic arch: A descriptive analysis

  • Chloe A. Joynt, MD

      Affiliations

    • Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • Charlene M.T. Robertson, MD

      Affiliations

    • Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
    • Department of Genetics, University of Alberta, Edmonton, Alberta, Canada
    • Corresponding Author InformationAddress for reprints: Charlene M. T. Robertson, MD, Room 242, GlenEast, Glenrose Rehabilitation Hospital, 10230 111 Ave, Edmonton, Alberta, Canada, T5G 0B7.
    • ,
  • Po-Yin Cheung, MD, PhD

      Affiliations

    • Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • Alberto Nettel-Aguirre, PhD

      Affiliations

    • Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
    • Post of Biostatistician, Research Methods Team, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
    • ,
  • Ari R. Joffe, MD

      Affiliations

    • Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • Reg S. Sauve, MD

      Affiliations

    • Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
    • ,
  • Wayne S.G. Biggs, BA

      Affiliations

    • Pediatric Rehabilitation Outcomes, Evaluation and Research, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
    • ,
  • Norma J. Leonard, MD

      Affiliations

    • Department of Genetics, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • David B. Ross, MD

      Affiliations

    • Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • Ivan M. Rebeyka, MD

      Affiliations

    • Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
    • Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • Western Canadian Complex Pediatric Therapies Follow-up Group

      Affiliations

    • Western Canadian Complex Pediatric Therapies Follow-up Group (D. Moddemann, Winnipeg, Manitoba, Canada, A. Synnes, Vancouver, British Columbia, Canada, and J. Bodani, Regina, Saskatchewan, Canada)

Received 20 August 2008; received in revised form 17 December 2008; accepted 8 March 2009. published online 24 June 2009.

Objective

This study determined neurodevelopmental outcomes of survivors of neonatal cardiac surgery for interrupted aortic arch through an interprovincial program and explored preoperative, intraoperative, and postoperative outcome predictors.

Methods

Children who underwent neonatal cardiac surgery for interrupted aortic arch at 6 weeks old or younger between 1996 and 2006 had a multidisciplinary neurodevelopmental assessment at 18 to 24 months old (mental and psychomotor developmental indices as mean ± SD and delay [score <70]). Survivor outcomes were compared by univariate and multivariate analyses and compared between children with and without chromosomal abnormality.

Results

Outcomes were available for all 26 survivors (mortality, 3.7%). Mental and psychomotor developmental indices were 75.8 ± 17.1 and 72.3 ± 16.9, respectively, with significantly lower scores for children with chromosomal abnormalities, which accounted for 29% of the variance in developmental indices. For the remaining 17 children without chromosomal abnormalities, mental and psychomotor developmental indices were 82.7 ± 14.5 and 79.1 ± 14.3, respectively, with deep hypothermic circulatory arrest time and Apgar score at 5 minutes contributing 46% of the variance in mental developmental index.

Conclusions

The neurodevelopmental indices of children who have undergone neonatal cardiac surgery for interrupted aortic arch are below normative values; those of children with chromosomal abnormalities are even lower. For children without a chromosomal abnormality, longer deep hypothermic circulatory arrest times and low Apgar scores predict lower mental developmental indices at 18 to 24 months of age.

Abbreviations and Acronyms: CI, confidence intervals, DHCA, deep hypothermic circulatory arrest, IAA, interrupted aortic arch, MDI, mental developmental index, PDI, psychomotor developmental index, RLFCP, regional low-flow cerebral perfusion

CTSNet classification: 20

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 Supported initially by the Glenrose Rehabilitation Hospital Research Trust Fund, with ongoing funding from the Registry and Follow-up of Complex Pediatric Therapies Project, Alberta Health and Wellness.

PII: S0022-5223(09)00420-6

doi:10.1016/j.jtcvs.2009.03.016

The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 4 , Pages 924-932, October 2009

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