Impact of operative and postoperative factors on neurodevelopmental outcomes after cardiac operations

Gaynor, J. William, Stopp, Christian, Wypij, David, Andropoulos, Dean B., Atallah, Joseph, Atz, Andrew M., Beca, John, Donofrio, Mary T., Duncan, Kim, Ghanayem, Nancy S., Goldberg, Caren S., Hovels-Gurich, Hedwig, Ichida, Fukiko, Jacobs, Jeffrey P., Justo, Robert, Latal, Beatrice, Li, Jennifer S., Mahle, William T., McQuillen, Patrick S., Menon, Shaji C., Pemberton, Victoria L., Pike, Nancy A., Pizarro, Christian, Shekerdemian, Lara S., Synnes, Anne, Williams, Ismee, Bellinger, David C. and Newburger, Jane W. (2016) Impact of operative and postoperative factors on neurodevelopmental outcomes after cardiac operations. Annals of Thoracic Surgery, 102 3: 843-849. doi:10.1016/j.athoracsur.2016.05.081


Author Gaynor, J. William
Stopp, Christian
Wypij, David
Andropoulos, Dean B.
Atallah, Joseph
Atz, Andrew M.
Beca, John
Donofrio, Mary T.
Duncan, Kim
Ghanayem, Nancy S.
Goldberg, Caren S.
Hovels-Gurich, Hedwig
Ichida, Fukiko
Jacobs, Jeffrey P.
Justo, Robert
Latal, Beatrice
Li, Jennifer S.
Mahle, William T.
McQuillen, Patrick S.
Menon, Shaji C.
Pemberton, Victoria L.
Pike, Nancy A.
Pizarro, Christian
Shekerdemian, Lara S.
Synnes, Anne
Williams, Ismee
Bellinger, David C.
Newburger, Jane W.
Title Impact of operative and postoperative factors on neurodevelopmental outcomes after cardiac operations
Journal name Annals of Thoracic Surgery   Check publisher's open access policy
ISSN 0003-4975
1552-6259
Publication date 2016-09-01
Sub-type Article (original research)
DOI 10.1016/j.athoracsur.2016.05.081
Open Access Status Not yet assessed
Volume 102
Issue 3
Start page 843
End page 849
Total pages 7
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Collection year 2017
Language eng
Formatted abstract
Background: Neurodevelopmental disability is common after operations for congenital heart defects. We previously showed that patient and preoperative factors, center, and calendar year of birth explained less than 30% of the variance for the Psychomotor Development Index (PDI) and the Mental Development Index (MDI) of the Bayley Scales of Infant Development-Second Edition. Here we investigate how much additional variance in PDI and MDI is contributed by operative variables and postoperative events.

Methods: We analyzed neurodevelopmental outcomes after operations with cardiopulmonary bypass at age 9 months or younger between 1996 and 2009. We used linear regression to investigate the effect of operative factors (age, weight, and cardiopulmonary bypass variables) and postoperative events on neurodevelopmental outcomes, adjusting for center, type of congenital heart defect, year of birth, and preoperative factors.

Results: We analyzed 1,770 children from 22 institutions with neurodevelopmental testing at age 13.3 months (range, 6 to 30 months). Among operative factors, longer total support time was associated with lower PDI and MDI (p < 0.05). When postoperative events were added, use of either extracorporeal membrane oxygenation or ventricular assist device support, and longer postoperative length of stay were associated with lower PDI and MDI (p < 0.05). Longer total support time was not a significant predictor in these models. After adjusting for patient, preoperative, intraoperative, and postoperative factors, measured intraoperative and postoperative factors accounted for 5% of the variances in PDI and MDI.

Conclusions: Operative factors may be less important than innate patient and preoperative factors and postoperative events in predicting early neurodevelopmental outcomes after cardiac operations in infants. Neurodevelopmental outcomes improved over calendar time when adjusted for patient and medical variables.
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Document type: Journal Article
Sub-type: Article (original research)
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