Is cardiac diagnosis a predictor of neurodevelopmental outcome after cardiac surgery in infancy?
Is cardiac diagnosis a predictor of neurodevelopmental outcome after cardiac surgery in infancy?
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DOI：
10.1016/j.jtcvs.2010.07.069
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发表时间：
2010-12-01
影响因子：
6
通讯作者：
Jarvik, Gail P.
中科院分区：
文献类型：
--
作者：
Gaynor, J. William;Gerdes, Marsha;Jarvik, Gail P.
目的：确定心脏诊断是否可以预测婴儿心脏手术后的神经发育结果。方法：对4岁时患有室间隔缺损(VSD)、法洛四联症(TOF)、大动脉转位(TGA)和左心发育不良综合征(HLHS)的婴儿进行了神经发育和遗传学评估。测试范围包括认知、语言、语言、记忆、执行功能、视觉运动、精细运动、阅读和数学技能。结果：178例遗传评估正常的患者完成了测试：VSD(n=26)、TOF(n=44)、TGA(n=41)和HLHS(n=67)。在胎龄、种族、载脂蛋白E基因型、社会经济地位或母亲受教育程度方面，各组之间没有发现差异。TGA和HLHS患者的首次手术年龄显著低于TOF和VSD患者。与TOF和VSD相比，HLHS组术后住院时间明显长于所有其他组，TGA组术后住院时间明显长于TOF组和VSD组。HLHS与深低温停循环和多次手术的使用显著相关。所有组的每个领域的平均得分都在正常范围内。与其他患者相比，HLHS患者在认知、精细运动技能、执行功能和数学技能方面的得分显著低于其他患者。TGA、TOF或VSD患者之间在任何领域均无显著差异。VSD、TOF、TGA和HLHS患者中至少1个领域的显著损害分别为8%(2/25)、20%(8/41)、17%(7/41)和18%(12/65)。经过人口统计学、术前和手术变量的校正后，在任何领域的组之间都没有发现显著差异。结论：对于VSD、TOF、TGA和HLHS手术后没有公认的遗传综合征的学龄前儿童，所测试的神经发育结果领域的平均得分在正常范围内。在每个诊断组中，与普通人群相比，至少在一个领域有障碍的儿童数量增加。与其他患者相比，HLHS患者未经调整的神经发育结果在认知、精细运动技能、执行功能和数学技能方面较低。在校正了人口统计学、术前和手术变量后，在任何领域的组之间都没有发现显著的差异。特定的心脏病诊断决定了这些协变量的很大一部分变异。因此，尽管HLHS确实在某些领域预测了较差的结果，但它并没有为考虑的其他因素增加预测能力。(《胸心外科杂志》2010；140：1230-7)
Objectives: To determine whether a cardiac diagnosis is a predictor of neurodevelopmental outcomes after infant cardiac surgery.Methods: Infants with ventricular septal defect (VSD), tetralogy of Fallot (TOF), transposition of the great arteries (TGA), and hypoplastic left heart syndrome (HLHS) in a study of apolipoprotein E (APOE) polymorphisms, and neurodevelopmental outcome underwent neurodevelopmental and genetic evaluation at 4 years of age. The domains tested included cognition, language, speech, memory, executive function, visual-motor, fine motor, and reading and math skills.Results: Testing was completed in 178 patients with normal genetic evaluations: VSD (n = 26), TOF (n = 44), TGA (n = 41), and HLHS (n = 67). No differences were found in gestational age, ethnicity, APOE genotype, socioeconomic status, or maternal education among groups. Patient age at the first surgery was significantly lower for patients with TGA and HLHS compared with those with TOF and VSD. The postoperative length of stay was significantly longer for HLHS than all other groups and for TGA compared with TOF and VSD. HLHS correlated significantly with the use of deep hypothermic circulatory arrest and multiple operations. The mean scores for each domain were within normal limits for all groups. Compared with the other patients, those with HLHS had significantly lower scores for cognition, fine motor skills, executive function, and math skills. No significant differences were found among the TGA, TOF or VSD patients for any domain. Significant impairments in at least 1 domain were identified in 8% (2/25) of patients with VSD, 20% (8/41) with TOF, 17% (7/41) with TGA, and 18% (12/65) with HLHS. After correction for the demographic, preoperative, and operative variables, no significant differences were found among the groups for any domain.Conclusions: The mean scores for the neurodevelopmental outcomes domains tested were in the normal range for preschool children with no recognized genetic syndromes after surgery for VSD, TOF, TGA, and HLHS. In each diagnostic group, the number of children with impairments in at least 1 domain increased compared with the general population. Unadjusted neurodevelopmental outcomes for HLHS were lower for cognition, fine motor skills, executive function, and math skills compared with the other patients. After correction for the demographic, preoperative, and operative variables, no significant differences were found among the groups for any domain. The specific cardiac diagnosis determines a large portion of the variation in these covariates. Therefore, although HLHS did predict for poorer outcomes in some domains, it did not add predictive power to the other factors considered. (J Thorac Cardiovasc Surg 2010;140:1230-7)