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Eur J Cardiothorac Surg 2004;26:920-925
© 2004 Elsevier Science NL
a 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
b Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
c Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
d Division of Neuropsychology, Children's Healthcare of Atlanta, , Emory University School of Medicine, Atlanta, GA, USA
Received 21 May 2004; received in revised form 13 July 2004; accepted 15 August 2004.
* Corresponding author. Tel.: +1 404 315 2672; fax: +1 404 325 6021. (E-mail: wmahle{at}emory.edu).
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±22min. 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.
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