title: Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: the Boston Circulatory Arrest Trial.
abstract: OBJECTIVE
  Our goal was to determine which of the two major methods of vital organ support used in infant cardiac surgery, total circulatory arrest and low-flow cardiopulmonary bypass, results in better neurodevelopmental outcomes at school age.
  
  
  METHODS
  In a single-center trial, infants with dextrotransposition of the great arteries underwent the arterial switch operation after random assignment to either total circulatory arrest or low-flow cardiopulmonary bypass. Developmental, neurologic, and speech outcomes were assessed at 8 years of age in 155 of 160 eligible children (97%).
  
  
  RESULTS
  Treatment groups did not differ in terms of most outcomes, including neurologic status, Full-Scale or Performance IQ score, academic achievement, memory, problem solving, and visual-motor integration. Children assigned to total circulatory arrest performed worse on tests of motor function including manual dexterity with the nondominant hand (P =.003), apraxia of speech (P =.01), visual-motor tracking (P =.01), and phonologic awareness (P =.003). Assignment to low-flow cardiopulmonary bypass was associated with a more impulsive response style on a continuous performance test of vigilance (P <.01) and worse behavior as rated by teachers (P =.05). Although mean scores on most outcomes were within normal limits, neurodevelopmental status in the cohort as a whole was below expectation in many respects, including academic achievement, fine motor function, visual-spatial skills, working memory, hypothesis generating and testing, sustained attention, and higher-order language skills.
  
  
  CONCLUSIONS
  Use of total circulatory arrest to support vital organs during heart surgery in infancy is generally associated with greater functional deficits than is use of low-flow cardiopulmonary bypass, although both strategies are associated with increased risk of neurodevelopmental vulnerabilities.
authors.affiliation: Department of Neurology, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA. david.bellinger@tch.harvard.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Bellinger
authors.forename: David
authors.initials: D
authors.lastname: Wypij
authors.forename: Adre J
authors.initials: AJ
authors.lastname: duPlessis
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Rappaport
authors.forename: Richard A
authors.initials: RA
authors.lastname: Jonas
authors.forename: Gil
authors.initials: G
authors.lastname: Wernovsky
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
mesh_terms: D001900:Boston; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D007361:Intelligence Tests; D008297:Male; D019957:Motor Skills Disorders / Q000175:diagnosis / Q000209:etiology*; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome