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 .
The effect of duration of deep hypothermic circulatory arrest in infant heart surgery on late neurodevelopment: the Boston Circulatory Arrest Trial.
OBJECTIVES Despite the technical advantages of total circulatory arrest for vital organ support during infant heart surgery , many centers have moved away from its use because of the demonstrated effects of circulatory arrest of long duration on neurodevelopmental outcomes . Our goal was to determine the functional form of the association between duration of circulatory arrest and risk of neurodevelopmental dysfunction . METHODS From 1988 to 1992 , in a single-center trial , infants with d-transposition of the great arteries underwent the arterial switch operation after r and om assignment to circulatory arrest or low-flow bypass .  The alpha-stat method was used , and hematocrit on bypass was maintained at 20 % . Developmental , neurologic , and speech outcomes were assessed at 8 years of age in 155 of 160 eligible children ( 97 % ) . Outcomes selected for analysis were Full-Scale , Verbal , and Performance IQ , Reading and Mathematics Composite , time to complete the Grooved Pegboard ( dominant h and ) , and the Mayo Test for Apraxia . RESULTS Nonparametric regression and piecewise linear models indicated that neurodevelopmental outcomes were generally not adversely affected unless the duration of circulatory arrest exceeded a threshold of 41 minutes ( 95 % 1-sided lower confidence limit of 32 minutes ) . CONCLUSIONS We found that the effect of duration of total circulatory arrest on later neurodevelopmental outcomes is nonlinear , with little influence at shorter duration s and with steadily worsening outcomes after longer duration s of circulatory arrest . Because the effects of duration of circulatory arrest may vary according to diagnosis , age at surgery , and other bypass and perioperative variables , this study can not ascertain a universally " safe " duration of total circulatory arrest
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 .