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Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations.

Publication ,  Conference
International Cardiac Collaborative on Neurodevelopment (ICCON) Investigators,
Published in: Ann Thorac Surg
September 2016

BACKGROUND: Neurodevelopmental disability is common after operations for congenital heart defects. We previously showed that patient and preoperative factors, center, and calendar year of birth explained less than 30% of the variance for the Psychomotor Development Index (PDI) and the Mental Development Index (MDI) of the Bayley Scales of Infant Development-Second Edition. Here we investigate how much additional variance in PDI and MDI is contributed by operative variables and postoperative events. METHODS: We analyzed neurodevelopmental outcomes after operations with cardiopulmonary bypass at age 9 months or younger between 1996 and 2009. We used linear regression to investigate the effect of operative factors (age, weight, and cardiopulmonary bypass variables) and postoperative events on neurodevelopmental outcomes, adjusting for center, type of congenital heart defect, year of birth, and preoperative factors. RESULTS: We analyzed 1,770 children from 22 institutions with neurodevelopmental testing at age 13.3 months (range, 6 to 30 months). Among operative factors, longer total support time was associated with lower PDI and MDI (p < 0.05). When postoperative events were added, use of either extracorporeal membrane oxygenation or ventricular assist device support, and longer postoperative length of stay were associated with lower PDI and MDI (p < 0.05). Longer total support time was not a significant predictor in these models. After adjusting for patient, preoperative, intraoperative, and postoperative factors, measured intraoperative and postoperative factors accounted for 5% of the variances in PDI and MDI. CONCLUSIONS: Operative factors may be less important than innate patient and preoperative factors and postoperative events in predicting early neurodevelopmental outcomes after cardiac operations in infants. Neurodevelopmental outcomes improved over calendar time when adjusted for patient and medical variables.

Duke Scholars

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

September 2016

Volume

102

Issue

3

Start / End Page

843 / 849

Location

Netherlands

Related Subject Headings

  • Respiratory System
  • Male
  • Infant
  • Humans
  • Heart Defects, Congenital
  • Female
  • Child, Preschool
  • Child Development
  • Cardiopulmonary Bypass
  • Cardiac Surgical Procedures
 

Citation

APA
Chicago
ICMJE
MLA
NLM
International Cardiac Collaborative on Neurodevelopment (ICCON) Investigators, . (2016). Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations. In Ann Thorac Surg (Vol. 102, pp. 843–849). Netherlands. https://doi.org/10.1016/j.athoracsur.2016.05.081
International Cardiac Collaborative on Neurodevelopment (ICCON) Investigators, S. “Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations.” In Ann Thorac Surg, 102:843–49, 2016. https://doi.org/10.1016/j.athoracsur.2016.05.081.
International Cardiac Collaborative on Neurodevelopment (ICCON) Investigators. Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations. In: Ann Thorac Surg. 2016. p. 843–9.
International Cardiac Collaborative on Neurodevelopment (ICCON) Investigators, S. “Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations.Ann Thorac Surg, vol. 102, no. 3, 2016, pp. 843–49. Pubmed, doi:10.1016/j.athoracsur.2016.05.081.
International Cardiac Collaborative on Neurodevelopment (ICCON) Investigators. Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations. Ann Thorac Surg. 2016. p. 843–849.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

September 2016

Volume

102

Issue

3

Start / End Page

843 / 849

Location

Netherlands

Related Subject Headings

  • Respiratory System
  • Male
  • Infant
  • Humans
  • Heart Defects, Congenital
  • Female
  • Child, Preschool
  • Child Development
  • Cardiopulmonary Bypass
  • Cardiac Surgical Procedures