Short-And Mid-Term Effects Of Extracorporeal Circulation On Cognitive Function Of Children With Congenital Heart Disease

Objective To evaluate dynamic changes in cognitive and academic functioning in 4-year-old survivors of serious congenital heart disease (CHD) following cardiac surgery with cardiopulmonary bypass (CPB) and without congenital cognitive impairments ( such as Down's syndrome, William's syndrome) at postoperative 1 week, 1month, 3 months and 6 months.Methods 130 children with a range of cyanotic and acyanotic conditions, aged 0-4 years, who under cardiac surgery with CPB complete a neuropsychological and behavioural evaluation. The evaluation was performed using Gesell developmental schedules (GDS) preoperatively and at postoperative 1 week, 1month, 3 months and 6 months. The related information of children with CHD, namely age, sex, weight, disease type, situation of CPB (time of CPB, time of aorta block, the lowest nasopharyngeal temperature, the lowest rectal temperature) and the residence time in ICU, was collected.Results (1)Preoperatively, the GDS scores of all 4 items of cognitive functioning were low among children with CHD. The GDS scores in the cyanotic children were significantly lower than those in the acyanotic children (P < 0.01)(2)As compared to the preoperative GDS scores of all 4 items, all corresponding postoperative scores showed an obvious decrease in the first week postoperatively (P< 0.01); however, subsequently, the scores increased significantly at 1, 3, and 6 months (P < 0.01). The scores increased gradually with time and finally reached the normal level. The GDS scores in the cyanotic children were significantly lower than those in the acyanotic children in the first 6 months postoperatively (P < 0.01); however, the difference was not statistically significant after 6 months (P < 0.05). ( 3 ) CPB only affected the GDS scores in the first month postoperatively, and the effect was greater in cyanotic children than in acyanotic children. The GDS scores negatively correlated with the age at each time point.Conclusions In general, the advantage of effect of open-heart surgery with CPB on the developments of cognitive functioning and body of 0~4 years old children with CHD is greater than the disadvantage. When all conditions permit, children with CHD should have surgical treatment as early as possible.The younger the children have cardiac surgery, the more significant the GST score increases. Their cognitive functioning improve gradually in postoperative 6 months, near and catching up with normal children of the same age; there was no longer difference between cyanotic and acyanotic groups.