Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations

J. William Gaynor, Christian Stopp, David Wypij, Dean B. Andropoulos, Joseph Atallah, Andrew M. Atz, John Beca, Mary T. Donofrio, Kim Duncan, Nancy S. Ghanayem, Caren S. Goldberg, Hedwig Hövels-Gürich, Fukiko Ichida, Jeffrey P. Jacobs, Robert Justo, Beatrice Latal, Jennifer S. Li, William T. Mahle, Patrick S. McQuillen, Shaji C. MenonVictoria L. Pemberton, Nancy A. Pike, Christian Pizarro, Lara S. Shekerdemian, Anne Synnes, Ismee Williams, David C. Bellinger, Jane W. Newburger

Research output: Contribution to journalArticlepeer-review

97 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)843-849
Number of pages7
JournalAnnals of Thoracic Surgery
Issue number3
StatePublished - Sep 1 2016

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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