Abstract 12437: Early Neurodevelopmental Outcomes after Cardiac Surgery in Infancy Have Not Improved: A Multi-center Retrospective Analysis of 1,718 Patients
Background: Neurodevelopmental (ND) disability is common in survivors of surgery for congenital heart disease (CHD). We explored whether ND outcomes following cardiac surgery in infancy have improved over time.
Methods: Data were submitted from 25 centers/consortia in 6 countries for 2,450 patients (pts) who were born 1989-2009 and underwent cardiac surgery with cardiopulmonary bypass at age ≤ 9 mo. with ND testing at age 6[[Unable to Display Character: &–]]30 mo. Of these, 1,718 pts (22 centers/5 countries) born 1996-2009 were tested with the Bayley Scales of Infant Development-II and form the study cohort. Multivariable linear regression and generalized additive models were used to identify preoperative and patient risk factors for ND outcomes after adjusting for year of birth, center, and CHD class (I=2 Ventricle [Vent]/no arch obstruction [AO], II=2 Vent/+AO, III=1Vent/no AO, IV=1Vent/+AO). Genetic factors were not included due to differences in ascertainment over time.
Results: Pts were assessed at age 14±4 (mean±SD) mo. Psychomotor Development Index (PDI; 77.7±18.8) and Mental Development Index (MDI; 88.5±16.6) scores were lower than normative means (both P<.0001). Surgery in more recent years was not associated with better PDI or MDI scores when adjusting for center and CHD class. Independent risk factors (preoperative and pt) for lower PDI (R2=17.7%) were higher CHD class (P<.0001), lower birth weight (P<.0001), being non-Hispanic Caucasian (P=.02), and age at first open heart surgery >30 days (P=.04). Independent risk factors for lower MDI (R2=18.0%) were higher CHD class (P=.0001), lower birth weight (P<.0001), lower maternal education (P=.0001), age at first open heart surgery >30 days (P=.002), and male sex (P=.006). We found no evidence of improvement in PDI or MDI scores since 1996 (0.31 points/yr, 95% CI = [−0.10, 0.72], P=.14, and 0.24 points/yr, [−0.15, 0.63], P=.23, respectively) after adjusting for these additional factors. Prenatal diagnosis was not an independent predictor of better performance for PDI or MDI.
Conclusion: Despite advances in care, early ND performance has not improved for survivors of cardiac surgery in infancy. Future research should explore innate factors and evolving patterns of care that could be impeding achievement of better ND outcomes.
- © 2012 by American Heart Association, Inc.