| Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. | |
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MedLine Citation:
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PMID: 7838188 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Deep hypothermia with either total circulatory arrest or low-flow cardiopulmonary bypass is used to support vital organs during heart surgery in infants. We compared the developmental and neurologic sequelae of these two strategies one year after surgery. METHODS: Infants with D-transposition of the great arteries who underwent an arterial-switch operation were randomly assigned to a method of support consisting predominantly of circulatory arrest or a method consisting predominantly of low-flow bypass. Developmental and neurologic evaluations and magnetic resonance imaging (MRI) were performed at one year of age. RESULTS: Of the 171 patients enrolled in the study, 155 were evaluated. After adjustment for the presence or absence of a ventricular septal defect, the infants assigned to circulatory arrest, as compared with those assigned to low-flow bypass, had a lower mean score on the Psychomotor Development Index of the Bayley Scales of Infant Development (a 6.5-point deficit, P = 0.01) and a higher proportion had scores < or = 80 (i.e., 2 SD or more below the population mean) (27 percent vs. 12 percent, P = 0.02). The score on the Psychomotor Development Index was inversely related to the duration of circulatory arrest (P = 0.02). The risk of neurologic abnormalities increased with the duration of circulatory arrest (P = 0.04). The method of support was not associated with the prevalence of abnormalities on MRI scans of the brain, scores on the Mental Development Index of the Bayley Scale, or scores on a test of visual-recognition memory. Perioperative electroencephalographic seizure activity was associated with lower scores on the Psychomotor Development Index (P = 0.002) and an increased likelihood of abnormalities on MRI scans of the brain (P < 0.001). CONCLUSIONS: Heart surgery performed with circulatory arrest as the predominant support strategy is associated with a higher risk of delayed motor development and neurologic abnormalities at the age of one year than is surgery with low-flow bypass as the predominant support strategy. |
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Authors:
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D C Bellinger; R A Jonas; L A Rappaport; D Wypij; G Wernovsky; K C Kuban; P D Barnes; G L Holmes; P R Hickey; R D Strand |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: The New England journal of medicine Volume: 332 ISSN: 0028-4793 ISO Abbreviation: N. Engl. J. Med. Publication Date: 1995 Mar |
Date Detail:
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Created Date: 1995-03-02 Completed Date: 1995-03-02 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 549-55 Citation Subset: AIM; IM |
Affiliation:
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Department of Neurology, Children's Hospital, Boston, MA 02115. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Brain
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physiopathology* Cardiopulmonary Bypass / methods* Child Development* Creatine Kinase / metabolism Electroencephalography Female Humans Hypothermia, Induced* Infant Intelligence Tests Isoenzymes / metabolism Magnetic Resonance Imaging Male Neurologic Examination Prospective Studies Psychomotor Performance* Transposition of Great Vessels / physiopathology, psychology, surgery |
| Grant Support | |
ID/Acronym/Agency:
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HL41786/HL/NHLBI NIH HHS; P30-HD18655/HD/NICHD NIH HHS; RR02172/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Isoenzymes; EC 2.7.3.2/Creatine Kinase |
| Comments/Corrections | |
Comment In:
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N Engl J Med. 1995 Aug 10;333(6):391; author reply 391-2
[PMID:
7609768
]
N Engl J Med. 1995 Aug 10;333(6):391; author reply 391-2 [PMID: 7609769 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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