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CPB surgery not linked to neurocognitive decline in children with CHD
Quartermain MD. Pediatrics. 2010;126:e351-e359.
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Previous research has demonstrated a correlation between cardiopulmonary bypass surgery and neurocognitive decline among infants undergoing surgery for complex congenital heart disease. However, according to researchers from The Children’s Hospital of Philadelphia, school-aged children undergoing surgery for acyanotic congenital heart disease did not experience significant neuropsychological complications after surgery.
The prospective study included 35 patients aged 5 to 18 years undergoing repair of acyanotic congenital heart disease. To determine the independent effects of cardiopulmonary bypass (CPB) on neurocognitive function, the researchers evaluated the independent effects of anesthesia, surgery and hospitalization in a surgical control group of 19 patients undergoing pectus deformity repair. Twelve children in an outpatient group were enrolled to examine the practice effects of serial testing. As part of the neuropsychological testing, researchers evaluated intelligence, memory, motor, attention, executive function and behavior before and 6 months after surgery.
Neuropsychological function was similar among all three groups at baseline. Twenty-three patients in the CPB group and 11 in the non-CPB group were examined preoperatively and postoperatively; 21 of CPB patients and all 11 non-CPB patients had normal neurologic status on both evaluations.
The researchers reported a trend toward mild improvement in postoperative scores, which they attributed to serial testing. There were no significant differences in memory, attention, fine or gross motor, general intelligence, visual motor integration or behavior among the CPB and non-CPB groups.
“Potential neuropsychological sequelae of CPB in this group of children and adolescents at low risk should not be a major factor in the decision to recommend surgical intervention for acyanotic congenital heart disease in childhood,” the researchers wrote.