Published online July 26, 2010
PEDIATRICS (doi:10.1542/peds.2009-2822)

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Articles

Neuropsychological Status in Children After Repair of Acyanotic Congenital Heart Disease

Michael D. Quartermain, MD^a, Richard F. Ittenbach, PhD^b, Thomas B. Flynn, PhD^c, J. William Gaynor, MD^d, Xuemei Zhang, MS^e, Daniel J. Licht, MD^f, Rebecca N. Ichord, MD^f, Michael L. Nance, MD^g, Gil Wernovsky, MD^a,h,i

Divisions of ^aCardiology,
^fNeurology, and
ⁱCritical Care Medicine,
Department of Pediatrics, ^hDepartment of Anesthesia,
^cDepartment of Psychology,
Divisions of ^dCardiothoracic Surgery and
^gGeneral Surgery, Department of Surgery, and
^eDivision of Biostatistics and Data Management, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
^bDivisions of Cardiology, Biostatistics, and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

Objectives The majority of previous studies that described the neuropsychological effects of cardiopulmonary bypass (CPB) in children were performed after surgery in infancy for complex congenital heart disease (CHD). We sought to limit confounding variables and isolate potential independent effects of CPB by describing neuropsychological function in school-aged children after repair of acyanotic CHD.

Methods This was a prospective study of patients who were aged 5 to 18 years and undergoing repair of acyanotic CHD. Neuropsychological testing battery included assessment of intelligence, memory, motor, attention, executive function, and behavior before and 6 months after CPB. The independent effects of anesthesia, surgery, and hospitalization on neuropsychological function were assessed by testing a surgical control group of patients who were undergoing repair of pectus deformities. In addition, an outpatient group of children with mild CHD were enrolled to assess the practice effects of serial testing.

Results Patients included CPB (n = 35), surgical control (n = 19), and nonsurgical (n = 12). Groups were comparable in age, gender, and race and demonstrated similar unadjusted group mean scores on baseline and 6-month follow-up neuropsychological testing. When adjusted for practice effects, the CPB group performed similar to the non-CPB groups in all assessed neuropsychological domains, with the exception of 1 of 4 tests of executive function.

Conclusions When controlling for the non-CPB effects of surgery (eg, hospitalization, anesthesia, thoracotomy) and the practice effects of serial testing, there were no consistent independent effects of CPB on neuropsychological status in a cohort of children and adolescents 6 months after repair of acyanotic CHD.

Key Words: congenital heart disease • neuropsychological • central nervous system • cardiopulmonary bypass • cognition • behavior

Abbreviations: CPB = cardiopulmonary bypass • CHD = congenital heart disease • RSI = reliability stability index • BSRT = Buschke Selective Reminding Test • BVRT = Benton's Visual Retention Test • TOL-DX = Tower of London, Drexel Version • WASI = Wechsler Abbreviated Scale of Intelligence • VMI = Berry-Buktenica Developmental Test of Visual-Motor Integration • BASC = Behavior Assessment System for Children: Parent Rating Scales • SES = socioeconomic status • ASD = atrial septal defect

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Accepted Apr 27, 2010.

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