Outcomes from an interprovincial program of newborn open heart surgery

Robertson, Charlene M.T.; Joffe, Ari R.; Sauve, Reginald S.; Rebeyka, Ivan M.; Phillipos, Ernest; Dyck, John D.; Harder, James A.

doi:10.1016/j.jpeds.2003.09.048

Cited by 69 publications

(111 citation statements)

References 43 publications

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“…As described previously, 11,12 infants Յ6 weeks of age were identified at the time of complex cardiac surgery and were followed up prospectively. In the present study, we included all patients with the diagnosis of HLHS or its variants who had undergone the Norwood procedure between September 1996 and July 2005.…”

Section: Methodsmentioning

confidence: 99%

“…Predetermined demographic, preoperative, intraoperative, and postoperative variables were collected prospectively. 11,12 Long-term follow-up was discussed with parents or guardians once survival was probable, and with their written consent, contact was made with their respective follow-up clinics at the tertiary site of origin.…”

Section: Methodsmentioning

confidence: 99%

“…History and physical measurements were obtained as described previously. 11,12 The family socioeconomic status was determined with the Blishen Index. 13 Maternal education was indicated by years of schooling.…”

Section: Early Childhood Assessmentsmentioning

confidence: 99%

“…Pediatricians experienced in neurodevelopmental follow-up examined each child for evidence of cerebral palsy 14 or visual impairment, defined as corrected visual acuity in the better eye of Ͻ20/60. 11,12 Hearing was evaluated by experienced certified pediatric audiologists in soundproof environments as described previously. 11,12 Sensorineural hearing impairment was defined as responses in the better ear of Ͼ40 dB at any frequency from 250 to 4000 Hz.…”

Section: Early Childhood Assessmentsmentioning

confidence: 99%

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Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure

Atallah

Dinu²,

Joffe³

et al. 2008

Circulation

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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 prospectively. 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 (nϭ62; 1996 to 2002) or the Norwood-RVPA era (nϭ32; 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 (Pϭ0.002) and the psychomotor developmental index (Pϭ0.029) 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.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Early Childhood Assessmentsmentioning

confidence: 99%

Section: Early Childhood Assessmentsmentioning

confidence: 99%

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Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure

Atallah

Dinu²,

Joffe³

et al. 2008

Circulation

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“…This is supported by the fact that EEG slowing was associated with less oxido-inflammatory stress. Abbreviations AC, aortic cross-clamping CPB, cardiopulmonary bypass FFT, fast Fourier transformation max delta-␦P, maximum difference between pre-and postoperative delta power MDA, malondialdehyde MDA-TNL, malondialdehyde corrected for total neutral lipids ␦P, delta power delta-␦P, difference between pre-and postoperative delta power Cardiac surgery with cardiopulmonary bypass (CPB) in children and neonates is frequently associated with acute neurologic symptoms and long-term neurologic deficits (1)(2)(3)(4). Neuropsychological deficits persist in a substantial number of patients.…”

mentioning

confidence: 99%

Electroencephalographic Changes after Pediatric Cardiac Surgery with Cardiopulmonary Bypass: Is Slow Wave Activity Unfavorable?

et al. 2005

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Pediatric cardiac surgery with cardiopulmonary bypass (CPB) is frequently associated with neurologic deficits. We describe the postoperative EEG changes, assess their possible causes, and evaluate their relevance to neurologic outcome. Thirty-one children and five neonates with congenital heart disease were included. EEG recording started after intubation and continued until 22-96 h after CPB. In addition to conventional analysis, spectral analysis was performed for occipital and frontal electrodes, and differences between pre-and postoperative delta power (delta-␦P) were calculated. Maximum values of occipital delta-␦P that occurred within 48 h after CPB were correlated with clinical variables and with perioperative markers of oxidative stress and inflammation. Occipital delta-␦P correlated with frontal delta-␦P, and maximum delta-␦P correlated with conventional rating. Distinct rise of ␦P was detected in 18 of 21 children without any acute or long-term neurologic deficits but only in five of 10 children with temporary or permanent neurologic deficits. Furthermore, maximally registered delta-␦P was inversely associated with duration of CPB and postoperative ventilation. Maximal delta-␦P was also inversely associated with the loss of plasma ascorbate (as an index of oxidative stress) and plasma levels of IL-6 and IL-8. Slow wave activity frequently occurs within 48 h after CPB. However, our data do not support the notion that EEG slowing is associated with adverse neurologic outcome. This is supported by the fact that EEG slowing was associated with less oxido-inflammatory stress. Abbreviations AC, aortic cross-clamping CPB, cardiopulmonary bypass FFT, fast Fourier transformation max delta-␦P, maximum difference between pre-and postoperative delta power MDA, malondialdehyde MDA-TNL, malondialdehyde corrected for total neutral lipids ␦P, delta power delta-␦P, difference between pre-and postoperative delta power Cardiac surgery with cardiopulmonary bypass (CPB) in children and neonates is frequently associated with acute neurologic symptoms and long-term neurologic deficits (1-4). Neuropsychological deficits persist in a substantial number of patients. During the intraoperative period, a global decrease in perfusion and oxygen delivery and focal ischemia related to embolic insults or diffuse microvascular changes are the principal mechanisms of brain damage (5). Systemic inflammation and reactive oxygen species generated by CPB might contribute to postoperative neurologic dysfunction (6,7). Impaired cerebral vasoregulation and ischemia/reperfusion injury continues in the early postoperative period (8,9). Postoperative cardiopulmonary dysfunction may additionally threaten cerebral perfusion pressure and oxygen delivery. However, there is an increased energy demand to restore neuronal membrane function and ionic gradients that are compromised by CPB.Events that affect the brain are usually followed by neuronal dysfunction, which can often be detected by EEG changes.

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Associated Noncardiac Problems

Hoffman

2009

The Natural and Unnatural History of Congenital Heart Disease

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Outcomes from an interprovincial program of newborn open heart surgery

Cited by 69 publications

References 43 publications

Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure

Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure

Electroencephalographic Changes after Pediatric Cardiac Surgery with Cardiopulmonary Bypass: Is Slow Wave Activity Unfavorable?

Associated Noncardiac Problems

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