Neuropsychological status in children after repair of acyanotic congenital heart disease.
OBJECTIVE
The majority of previous studies that described the neuropsychological effects of cardiopulmonary bypass (CPB) in children were performed after surgery in infancy for complex congenital heart disease (CHD). We sought to limit confounding variables and isolate potential independent effects of CPB by describing neuropsychological function in school-aged children after repair of acyanotic CHD.


METHODS
This was a prospective study of patients who were aged 5 to 18 years and undergoing repair of acyanotic CHD. Neuropsychological testing battery included assessment of intelligence, memory, motor, attention, executive function, and behavior before and 6 months after CPB. The independent effects of anesthesia, surgery, and hospitalization on neuropsychological function were assessed by testing a surgical control group of patients who were undergoing repair of pectus deformities. In addition, an outpatient group of children with mild CHD were enrolled to assess the practice effects of serial testing.


RESULTS
Patients included CPB (n = 35), surgical control (n = 19), and nonsurgical (n = 12). Groups were comparable in age, gender, and race and demonstrated similar unadjusted group mean scores on baseline and 6-month follow-up neuropsychological testing. When adjusted for practice effects, the CPB group performed similar to the non-CPB groups in all assessed neuropsychological domains, with the exception of 1 of 4 tests of executive function.


CONCLUSIONS
When controlling for the non-CPB effects of surgery (eg, hospitalization, anesthesia, thoracotomy) and the practice effects of serial testing, there were no consistent independent effects of CPB on neuropsychological status in a cohort of children and adolescents 6 months after repair of acyanotic CHD.
Quartermain
Michael D
MD
Divisions of Cardiology, Department of Anesthesia, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. quartermain@email.chop.edu
Ittenbach
Richard F
RF
Flynn
Thomas B
TB
Gaynor
J William
JW
Zhang
Xuemei
X
Licht
Daniel J
DJ
Ichord
Rebecca N
RN
Nance
Michael L
ML
Wernovsky
Gil
G
D000293:Adolescent; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D015331:Cohort Studies; D003490:Cyanosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011183:Postoperative Complications; D011446:Prospective Studies; D012720:Severity of Illness Index