Perioperative risk factors were inconsistently associated with developmental outcomes .
INTERPRETATION The literature on children undergoing surgery in early infancy suggests that infants with a single ventricle are at highest risk of adverse developmental outcomes .
WHAT THIS PAPER ADDS Children with complex congenital heart disease ( CHD ) are at increased risk of impaired developmental outcome .
Children with single-ventricle CHD have worse outcomes than children with two-ventricle CHD .
Children with two-ventricle CHD gradually grow out of their initial developmental impairment .
Perioperative factors are inconsistently associated with outcome
AIM ( 1 ) To systematic ally review the literature on developmental outcomes from infancy to adolescence of children with complex congenital heart disease ( CHD ) who underwent early surgery ; ( 2 ) to run a meta-regression analysis on the Bayley Scales of Infant Development , Second Edition Mental Developmental Index and Psychomotor Developmental Index ( PDI ) of infants up to 24 months and IQs of preschool-aged children to adolescents ; ( 3 ) to assess associations between perioperative risk factors and outcomes .
Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: the Boston Circulatory Arrest Trial.
OBJECTIVES Our goal was to determine which of the two major methods of vital organ support used in infant cardiac surgery , total circulatory arrest and low-flow cardiopulmonary bypass , results in better neurodevelopmental outcomes at school age . METHODS In a single-center trial , infants with dextrotransposition of the great arteries underwent the arterial switch operation after r and om assignment to either total circulatory arrest or low-flow cardiopulmonary bypass .  Developmental , neurologic , and speech outcomes were assessed at 8 years of age in 155 of 160 eligible children ( 97 % ) . RESULTS Treatment groups did not differ in terms of most outcomes , including neurologic status , Full-Scale or Performance IQ score , academic achievement , memory , problem solving , and visual-motor integration . Children assigned to total circulatory arrest performed worse on tests of motor function including manual dexterity with the nondominant h and ( P = .003 ) , apraxia of speech ( P = .01 ) , visual-motor tracking ( P = .01 ) , and phonologic awareness ( P = .003 ) . Assignment to low-flow cardiopulmonary bypass was associated with a more impulsive response style on a continuous performance test of vigilance ( P < .01 ) and worse behavior as rated by teachers ( P = .05 ) . Although mean scores on most outcomes were within normal limits , neurodevelopmental status in the cohort as a whole was below expectation in many respects , including academic achievement , fine motor function , visual-spatial skills , working memory , hypothesis generating and testing , sustained attention , and higher-order language skills . CONCLUSIONS Use of total circulatory arrest to support vital organs during heart surgery in infancy is generally associated with greater functional deficits than is use of low-flow cardiopulmonary bypass , although both strategies are associated with increased risk of neurodevelopmental vulnerabilities
Perioperative risk factors were inconsistently associated with developmental outcomes .
INTERPRETATION The literature on children undergoing surgery in early infancy suggests that infants with a single ventricle are at highest risk of adverse developmental outcomes .
WHAT THIS PAPER ADDS Children with complex congenital heart disease ( CHD ) are at increased risk of impaired developmental outcome .
Children with single-ventricle CHD have worse outcomes than children with two-ventricle CHD .
Children with two-ventricle CHD gradually grow out of their initial developmental impairment .
Perioperative factors are inconsistently associated with outcome
AIM ( 1 ) To systematic ally review the literature on developmental outcomes from infancy to adolescence of children with complex congenital heart disease ( CHD ) who underwent early surgery ; ( 2 ) to run a meta-regression analysis on the Bayley Scales of Infant Development , Second Edition Mental Developmental Index and Psychomotor Developmental Index ( PDI ) of infants up to 24 months and IQs of preschool-aged children to adolescents ; ( 3 ) to assess associations between perioperative risk factors and outcomes .