title: J. Maxwell Chamberlain Memorial Paper for congenital heart surgery. Deep hypothermic circulatory arrest does not impair neurodevelopmental outcome in school-age children after infant cardiac surgery.
abstract: BACKGROUND
  The purpose of this study was to assess deep hypothermic circulatory arrest (DHCA) as a modifier of neurodevelopmental (ND) outcomes in preschool children after cardiac surgery in infancy for repair of congenital heart defects (CHD).
  
  
  METHODS
  This is a planned analysis of infants enrolled in a prospective study of apolipoprotein E polymorphisms and ND outcome after cardiac surgery. The effect of DHCA was assessed in patients with single or biventricular CHD without aortic arch obstruction. Neurodevelopmental assessment at 4 years of age included cognition, language, attention, impulsivity, executive function, social competence, and visual-motor and fine-motor skills. Patient and procedural variables were evaluated in univariate and multivariate models.
  
  
  RESULTS
  Neurodevelopmental testing was completed in 238 of 307 eligible patients (78%). Deep hypothermic circulatory arrest was used at the discretion of the surgeon at least once in 92 infants (38.6%) with a median cumulative duration of 36 minutes (range, 1 to 132 minutes). By univariate analysis, DHCA patients were more likely to have single-ventricle CHD (p = 0.013), lower socioeconomic status (p < 0.001), a higher incidence of preoperative ventilation (p < 0.001), and were younger and smaller at the first surgery (p < 0.001). By multivariate analysis, use of DHCA was not predictive of worse performance for any ND outcome.
  
  
  CONCLUSIONS
  In this cohort of children undergoing repair of CHD in infancy, patients who underwent DHCA had risk factors associated with worse ND outcomes. Despite these, use of DHCA for repair of single-ventricle and biventricular CHD without aortic arch obstruction was not predictive of worse performance for any ND domain tested at 4 years of age.
authors.affiliation: Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. fullers@email.chop.edu
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fuller
authors.forename: Ramakrishnan
authors.initials: R
authors.lastname: Rajagopalan
authors.forename: Gail P
authors.initials: GP
authors.lastname: Jarvik
authors.forename: Marsha
authors.initials: M
authors.lastname: Gerdes
authors.forename: Judy
authors.initials: J
authors.lastname: Bernbaum
authors.forename: Gil
authors.initials: G
authors.lastname: Wernovsky
authors.forename: Robert R
authors.initials: RR
authors.lastname: Clancy
authors.forename: Cynthia
authors.initials: C
authors.lastname: Solot
authors.forename: Susan C
authors.initials: SC
authors.lastname: Nicolson
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
mesh_terms: D002648:Child; D002675:Child, Preschool; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects*; D003071:Cognition / Q000502:physiology*; D002658:Developmental Disabilities / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology