The short term effects of cardiopulmonary bypass on neurologic function in children and young adults.
OBJECTIVE
Cognitive deficits are common in adults following surgery utilizing cardiopulmonary bypass (CPB). A previous retrospective study suggested that surgical closure of an ASD in children was associated with neurologic injury, while transcather therapy was not. In a prospective study, we sought to determine whether neurologic deficits occur following repair of non-complex congenital heart lesions in school-age children and young adults.


METHODS
Inclusion criteria were: age between 5 and 20 years, cardiac surgery utilizing CPB without deep hypothermic circulatory arrest, and no prior cardiac surgery. Patients underwent psychometric testing 1-3 days prior to surgery and re-evaluation 7-18 days after surgery. In order to determine the test/re-test effect an age-matched cohort of children undergoing transcather closure of ASD under general anesthesia was also evaluated. The primary outcome measures were verbal and picture memory. Additional psychometric tests included: computerized performance test (CPT) and Digit Span (DS). Forty-one patients were enrolled, 29 undergoing surgery with CPB and 12 controls. Surgical procedures included ASD closure (n=13), VSD closure (n=10), resection of sub-aortic stenosis (n=3), mitral valvuloplasty (n=3). Mild hypothermia was used in all cases. The mean duration of CPB was 54+/-22 min.


RESULTS
There was no significant difference in any of the psychometric test scores between subjects undergoing surgery with CPB or controls.


CONCLUSIONS
There are no marked adverse neurologic effects of CPB in school-age children and young adults undergoing non-complex open-heart surgery. These data are important in counseling patients and families and should be considered in the debate as to the relative merits of transcather versus open-heart repair of various heart lesions.
Mahle
William T
WT
Department of Pediatrics, Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road, NE, Atlanta, GA 30322-1062, USA. wmahle@emory.edu
Lundine
Karen
K
Kanter
Kirk R
KR
Forbess
Joseph M
JM
Kirshbom
Paul
P
Tosone
Steven R
SR
Vincent
Robert N
RN
D000293:Adolescent; D000328:Adult; D000768:Anesthesia, General / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D008568:Memory; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011594:Psychometrics; D011930:Reaction Time