Outcome After Open-Heart Surgery in Infants and Children

Miller, Geoffrey; Tesman, Johanna R.; Ramer, Jeanette C.; Baylen, Barry G.; Myers, John L.

doi:10.1177/088307389601100112

Cited by 129 publications

(51 citation statements)

References 27 publications

(7 reference statements)

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“…The initial studies examining children with HLHS who had undergone the Norwood procedure reported that many (the majority, in some cases) subjects had severe developmental delays. 12,13 A number of more-recent, larger, single-institution studies generally found that mean fullscale IQ scores were in the range of the middle 80s to low 90s, suggesting that the majority of children with HLHS have mild impairments. 4,6,7 Mahle et al 6 reported a median full-scale IQ of 87 among 28 school-aged children with HLHS who had undergone staged palliation.…”

Section: Discussionmentioning

confidence: 99%

Relationship of Surgical Approach to Neurodevelopmental Outcomes in Hypoplastic Left Heart Syndrome

Visconti²,

et al. 2006

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OBJECTIVE. Two strategies for surgical management are used for infants with hypoplastic left heart syndrome (HLHS), primary heart transplantation and the Norwood procedure. We sought to determine how these 2 surgical approaches influence neurodevelopmental outcomes at school age. METHODS. A multicenter, cross-sectional study of neurodevelopmental outcomes among school-aged children (>8 years of age) with HLHS was undertaken between July 2003 and September 2004. Four centers enrolled 48 subjects, of whom 47 completed neuropsychologic testing. Twenty-six subjects (55%) had undergone the Norwood procedure and 21 (45%) had undergone transplantation, with an intention-to-treat analysis. The mean age at testing was 12.4 ± 2.5 years. Evaluations included the Wechsler Abbreviated Scale of Intelligence, Clinical Evaluation of Language Fundamentals, Wechsler Individual Achievement Test, and Beery-Buktenica Developmental Test of Visual-Motor Integration. RESULTS. The mean neurocognitive test results were significantly below population normative values. The mean full-scale IQ for the entire cohort was 86 ± 14. In a multivariate model, there was no association of surgical strategy with any measure of developmental outcome. A longer hospital stay, however, was associated significantly with lower verbal, performance, and full-scale IQ scores. Aortic valve atresia was associated with lower math achievement test scores. CONCLUSIONS. Neurodevelopmental deficits are prevalent among school-aged children with HLHS, regardless of surgical approach. Complications that result in prolonged hospitalization at the time of the initial operation are associated with neurodevelopmental status at school age.

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Section: Discussionmentioning

confidence: 99%

Relationship of Surgical Approach to Neurodevelopmental Outcomes in Hypoplastic Left Heart Syndrome

Visconti²,

et al. 2006

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“…105,164,166,168,169 Severe neurological complications are more common in children who have HLH [170][171][172][173] after surgery in younger infants (<3 months old), 171 in operations involving the aortic arch, 81 in surgery that is complicated by multiple organ failure 174 and possibly in acyanotic heart malformations. 175 As children grow older, the frequency of diagnosis of neurodevelopmental problems increases, particularly of neurological deficits (nerve palsies, dyspraxias, seizures, etc.)…”

Section: Neurological Outcomesmentioning

confidence: 99%

Newborn screening for congenital heart defects: a systematic review and cost-effectiveness analysis

Knowles¹,

Griebsch²,

Dezateux

et al. 2005

Health Technol Assess

209

143

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“…Although most morbidities encountered after surgical intervention are neurologic, renal failure, complete heart block, respiratory failure, and sepsis have also been documented. 8,12,[26][27][28][29][30][31][32][33][34] Despite decreasing surgical mortality and morbidity rates in the past decade, there is no consensus regarding the best treatment. Physicians and parents must still consider the choice between surgical palliation, OHT, and compassionate care.…”

mentioning

confidence: 99%

Clinical Outcomes and Secondary Diagnoses for Infants Born With Hypoplastic Left Heart Syndrome

et al. 2004

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ABSTRACT. Objective. To explore clinical outcomes and secondary diagnoses present at discharge for infants born with hypoplastic left heart syndrome (HLHS), from a national perspective.Methods. We examined hospitalizations for infants <30 days of age who were born with HLHS, using hospital discharge data from the 1997 Kids Inpatient Database. To explore treatment choices, clinical outcomes, and resource use, we used International Classification of Diseases, 9th Revision, Clinical Modification diagnostic and procedure codes to classify discharges according to type of surgical intervention versus no surgical intervention. To investigate outcomes in more detail, we identified secondary diagnoses noted at discharge, using International Classification of Diseases, 9th Revision, Clinical Modification codes, and stratified results according to type of surgical intervention.Results. Of a total of 550 patients with HLHS, 234 underwent the Norwood procedure, 17 underwent orthotopic heart transplantation, and 106 died in the hospital with no reported surgical intervention. Although we found no demographic variables to be significantly associated with the type of treatment received, discharged patients who died without surgical intervention were significantly more likely to have received care in hospitals identified as small (odds ratio [OR]: 1.5; 95% confidence interval [CI]: 1.03-3.1) or not children's hospitals (OR: 2.02; 95% CI: 1.13-3.6). Secondary diagnoses of cardiac arrest (OR: 2.0; 95% CI: 1.1-3.4) and seizures (OR: 2.6; 95% CI: 1.2-5.5) occurred more frequently in orthotopic heart transplantation cases than in Norwood procedure cases.Conclusions. These data from a national perspective reflect outcomes of infants with HLHS during a time when rates of initial survival after surgical intervention were considered to be improved. These findings may be useful to clinicians when they are considering and recommending initial medical and surgical strategies currently being proposed for the treatment of HLHS. H ypoplastic left heart syndrome (HLHS) remains one of the most complex congenital heart defects to treat, both medically and surgically. Despite advances in treatment, HLHS continues to have the highest mortality rate, of all congenital heart defects, for infants Ͻ1 year of age. 1 HLHS is a combination of congenital cardiac anomalies involving hypoplasia of the ascending aorta, aortic valve atresia or stenosis, a small or absent left ventricle, and mitral atresia or hypoplasia. 2 Before 1980, HLHS was considered universally fatal in the newborn period, leaving the health care team with the sole option of providing compassionate care. [2][3][4][5][6] Currently, most infants diagnosed as having HLHS undergo a series of surgical palliations; a small percentage undergo orthotopic heart transplantation (OHT) as an initial surgical approach. [7][8][9][10][11][12][13][14][15][16][17][18] As the rates of death after surgical intervention for HLHS have decreased, morbidities resulting from both surgical palliation and transpla...

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Outcome After Open-Heart Surgery in Infants and Children

Cited by 129 publications

References 27 publications

Relationship of Surgical Approach to Neurodevelopmental Outcomes in Hypoplastic Left Heart Syndrome

Relationship of Surgical Approach to Neurodevelopmental Outcomes in Hypoplastic Left Heart Syndrome

Newborn screening for congenital heart defects: a systematic review and cost-effectiveness analysis

Clinical Outcomes and Secondary Diagnoses for Infants Born With Hypoplastic Left Heart Syndrome

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