Neurodevelopmental Status at Eight Years in Children With Dextro-Transposition of the Great Arteries: The Boston Circulatory Arrest Trial

J Thorac Cardiovasc Surg. 2003 Nov;126(5):1385-96. doi: 10.1016/s0022-5223(03)00711-6.

Abstract

Objectives: Our goal was to determine which of the two major methods of vital organ support used in infant cardiac surgery, total circulatory arrest and low-flow cardiopulmonary bypass, results in better neurodevelopmental outcomes at school age.

Methods: In a single-center trial, infants with dextrotransposition of the great arteries underwent the arterial switch operation after random assignment to either total circulatory arrest or low-flow cardiopulmonary bypass. Developmental, neurologic, and speech outcomes were assessed at 8 years of age in 155 of 160 eligible children (97%).

Results: Treatment groups did not differ in terms of most outcomes, including neurologic status, Full-Scale or Performance IQ score, academic achievement, memory, problem solving, and visual-motor integration. Children assigned to total circulatory arrest performed worse on tests of motor function including manual dexterity with the nondominant hand (P =.003), apraxia of speech (P =.01), visual-motor tracking (P =.01), and phonologic awareness (P =.003). Assignment to low-flow cardiopulmonary bypass was associated with a more impulsive response style on a continuous performance test of vigilance (P <.01) and worse behavior as rated by teachers (P =.05). Although mean scores on most outcomes were within normal limits, neurodevelopmental status in the cohort as a whole was below expectation in many respects, including academic achievement, fine motor function, visual-spatial skills, working memory, hypothesis generating and testing, sustained attention, and higher-order language skills.

Conclusions: Use of total circulatory arrest to support vital organs during heart surgery in infancy is generally associated with greater functional deficits than is use of low-flow cardiopulmonary bypass, although both strategies are associated with increased risk of neurodevelopmental vulnerabilities.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Boston
  • Cardiac Surgical Procedures / adverse effects
  • Cardiac Surgical Procedures / methods
  • Cardiopulmonary Bypass / adverse effects*
  • Cardiopulmonary Bypass / methods
  • Child
  • Developmental Disabilities / diagnosis
  • Developmental Disabilities / etiology*
  • Female
  • Follow-Up Studies
  • Heart Arrest, Induced / adverse effects*
  • Heart Arrest, Induced / methods
  • Humans
  • Infant, Newborn
  • Intelligence Tests
  • Male
  • Motor Skills Disorders / diagnosis
  • Motor Skills Disorders / etiology*
  • Nervous System Diseases / diagnosis
  • Nervous System Diseases / etiology*
  • Neurologic Examination
  • Neuropsychological Tests
  • Probability
  • Prospective Studies
  • Reference Values
  • Risk Assessment
  • Severity of Illness Index
  • Transposition of Great Vessels / diagnosis
  • Transposition of Great Vessels / surgery*
  • Treatment Outcome