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 .
Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure: An Analysis of the Modified Blalock-Taussig Shunt and Right Ventricle–to–Pulmonary Artery Shunt Surgical Eras
Background — The Norwood procedure for stage 1 palliation of hypoplastic left heart syndrome is performed with either the modified Blalock-Taussig ( MBTS ) or the right ventricle – to – pulmonary artery ( RVPA ) shunt . In our institution , surgical practice changed from use of the MBTS to use of the RVPA shunt in 2002 . We analyzed survival and mental and psychomotor outcomes of the 2 consecutive surgical eras . Methods and Results — Between September 1996 and July 2005 , 94 neonates with hypoplastic left heart syndrome underwent the Norwood procedure .  Patients were recruited as neonates and followed up prospect ively . Health , mental , and psychomotor outcomes ( Bayley Scales of Infant Development-II ) were assessed at 2 years . The study subjects were from the Norwood-MBTS era ( n=62 ; 1996 to 2002 ) or the Norwood-RVPA era ( n=32 ; 2002 to 2005 ) . In the MBTS era , early and 2-year mortality rates were 23 % ( 14/62 ) and 52 % ( 32/62 ) ; the mean ( SD ) mental and psychomotor developmental indices were 79 ( 18 ) and 67 ( 19 ) . In the RVPA era , early and 2-year mortality rates were 6 % ( 2/32 ) and 19 % ( 6/32 ) ; the mean ( SD ) mental and psychomotor developmental indices were 85 ( 18 ) and 78 ( 18 ) . The 2-year mortality rate ( P=0.002 ) and the psychomotor developmental index ( P=0.029 ) were improved in the more recent surgical era . On multivariable Cox regression analysis , postoperative highest serum lactate independently predicted 2-year mortality in the MBTS and RVPA eras . Conclusions — Analysis of 2 consecutive surgical eras of hypoplastic left heart syndrome patients undergoing the Norwood procedure showed a significant improvement in 2-year survival and psychomotor development in the more recent era . Adverse neurodevelopmental outcome in this patient population remains a concern
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 .