Abstract 2595: Cardiopulmonary Bypass Does Not Cause Neurocognitive Decline in Children and Adolescents Undergoing Repair of Acyanotic Congenital Heart Disease
Background: Previous studies describing the neurocognitive (neuro) effects of cardiopulmonary bypass (CPB) have been performed following surgery in infancy for complex congenital heart disease (CHD) and in adults with acquired heart disease. These patients (pts) have many causes for adverse neuro outcomes with conflicting results regarding the contribution of CPB. The impact of CPB in children with less complex CHD is unknown. We sought to describe the effects of CPB on neuro function in children following repair of acyanotic CHD.
Methods: We performed a prospective cohort study of pts 5–18 yrs of age undergoing primary repair of CHD. Neuro testing battery included assessment of intellectual function (IQ), memory, motor skills, attention, executive function, and an evaluation by a pediatric neurologist pre- and 6 months post-CPB. Non-CPB effects of surgery were assessed by similarly testing pts undergoing repair of pectus excavatum (non-CPB). Practice effects of serial testing were controlled by enrolling non-surgical pts (mild CHD) and creating a reliability-stability index to adjust surgical group scores. Anxiety was assessed as a covariate.
Results: CPB pts (n=41) included repair of atrial  or ventricular  septal defect, coronary anomaly , aortic valve  or other . Control pts included pectus repair (n=20) and non-surgical CHD pts (n=16). Groups were similar in age, gender, race, socioeconomic status and baseline scores. Neurological exams before and after surgery were not different between groups. Controlling for the effects of serial testing, there were no significant (p<.05) changes in the mean scores of either surgical group in areas of IQ, memory, motor skills, attention, or executive function. In addition, there were no differences in the percentage of patients in either surgical group that had a significant (>1 SD) decline in scores after surgery.
Conclusions: When controlling for the non-CPB effects of surgery (hospitalization, anxiety, etc.) and the practice effects of serial testing, there were no independent effects of CPB on neuro status 6 months after repair of acyanotic CHD. We believe that the potential neuro sequelae of CPB should not be a major factor in the decision to recommend CHD surgery in otherwise healthy children.