title: Neurodevelopmental outcomes after congenital heart surgery and strategies for improvement.
abstract: OBJECTIVE
  The present review focuses on neurodevelopmental and neuropsychologic outcomes following neonatal and infant heart surgery for complex congenital heart lesions. The data include recent reports on perioperative MRI and recent results of randomized clinical trials addressing perioperative variables.
  
  
  RESULTS
  Advancements in magnetic resonance techniques have reinforced earlier data that newborns with complex congenital heart lesions are frequently born with brain immaturity. Randomized clinical trials have looked at several important perioperative candidate predictors as potential independent risk factors for worsened neurodevelopmental outcomes: no difference was found between regional cerebral perfusion and deep hypothermic circulatory arrest on 1-year outcomes; no difference was found between the modified Blalock-Taussig shunt and the right ventricular to pulmonary artery shunt as part of the Norwood procedure on 14-month outcomes; at 16-year testing for individuals with transposition of the great arteries following the arterial switch operation, no significant difference was found between low-flow cardiopulmonary bypass and deep hypothermic circulatory arrest.
  
  
  CONCLUSIONS
  Randomized clinical, cross-sectional, and prospective trials have explored robust analyses looking for independent risk factors for worsened neurodevelopmental outcomes. Most of these risk factors are patient-related or socioeconomic, with only a few potentially modifiable.
authors.affiliation: University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA. tabbutts@peds.ucsf.edu
authors.forename: Sarah
authors.initials: S
authors.lastname: Tabbutt
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002658:Developmental Disabilities / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D009483:Neuropsychological Tests; D011379:Prognosis; D012307:Risk Factors