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 journalArticle

50 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)843-849
Number of pages7
JournalAnnals of Thoracic Surgery
Volume102
Issue number3
DOIs
StatePublished - Sep 1 2016

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Congenital Heart Defects
Cardiopulmonary Bypass
Parturition
Extracorporeal Membrane Oxygenation
Heart-Assist Devices
Age Factors
Child Development
Linear Models
Length of Stay
Weights and Measures
Calendars

ASJC Scopus subject areas

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

Cite this

Gaynor, J. W., Stopp, C., Wypij, D., Andropoulos, D. B., Atallah, J., Atz, A. M., ... Newburger, J. W. (2016). Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations. Annals of Thoracic Surgery, 102(3), 843-849. https://doi.org/10.1016/j.athoracsur.2016.05.081

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.; Hövels-Gürich, 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.

In: Annals of Thoracic Surgery, Vol. 102, No. 3, 01.09.2016, p. 843-849.

Research output: Contribution to journalArticle

Gaynor, JW, Stopp, C, Wypij, D, Andropoulos, DB, Atallah, J, Atz, AM, Beca, J, Donofrio, MT, Duncan, K, Ghanayem, NS, Goldberg, CS, Hövels-Gürich, H, Ichida, F, Jacobs, JP, Justo, R, Latal, B, Li, JS, Mahle, WT, McQuillen, PS, Menon, SC, Pemberton, VL, Pike, NA, Pizarro, C, Shekerdemian, LS, Synnes, A, Williams, I, Bellinger, DC & Newburger, JW 2016, 'Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations', Annals of Thoracic Surgery, vol. 102, no. 3, pp. 843-849. https://doi.org/10.1016/j.athoracsur.2016.05.081
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. ; Hövels-Gürich, 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. / Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations. In: Annals of Thoracic Surgery. 2016 ; Vol. 102, No. 3. pp. 843-849.
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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.",
author = "Gaynor, {J. William} and Christian Stopp and David Wypij and Andropoulos, {Dean B.} and Joseph Atallah and Atz, {Andrew M.} and John Beca and Donofrio, {Mary T.} and Kim Duncan and Ghanayem, {Nancy S.} and Goldberg, {Caren S.} and Hedwig H{\"o}vels-G{\"u}rich and Fukiko Ichida and Jacobs, {Jeffrey P.} and Robert Justo and Beatrice Latal and Li, {Jennifer S.} and Mahle, {William T.} and McQuillen, {Patrick S.} and Menon, {Shaji C.} and Pemberton, {Victoria L.} and Pike, {Nancy A.} and Christian Pizarro and Shekerdemian, {Lara S.} and Anne Synnes and Ismee Williams and Bellinger, {David C.} and Newburger, {Jane W.}",
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T1 - Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations

AU - Gaynor, J. William

AU - Stopp, Christian

AU - Wypij, David

AU - Andropoulos, Dean B.

AU - Atallah, Joseph

AU - Atz, Andrew M.

AU - Beca, John

AU - Donofrio, Mary T.

AU - Duncan, Kim

AU - Ghanayem, Nancy S.

AU - Goldberg, Caren S.

AU - Hövels-Gürich, Hedwig

AU - Ichida, Fukiko

AU - Jacobs, Jeffrey P.

AU - Justo, Robert

AU - Latal, Beatrice

AU - Li, Jennifer S.

AU - Mahle, William T.

AU - McQuillen, Patrick S.

AU - Menon, Shaji C.

AU - Pemberton, Victoria L.

AU - Pike, Nancy A.

AU - Pizarro, Christian

AU - Shekerdemian, Lara S.

AU - Synnes, Anne

AU - Williams, Ismee

AU - Bellinger, David C.

AU - Newburger, Jane W.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - 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.

AB - 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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