Neurological and Cognitive Development of School-Aged and Young Patients Who Received Aortic Arch Surgery Using Antegrade Selective Cerebral Perfusion in Neonatal and Infancy Period

Objectives: The aim of this study was the evaluation of the neurocognitive long-term outcomes of children who underwent neonatal and infantile cardiac surgery with antegrade selective cerebral perfusion (ASCP). Frequency and extent of cognitive disorders, intelligent quotient (IQ), motor skills, attention, behavior, and health-related quality of life (HRQL) were identified and compared with healthy subjects.

Methods: Twenty-two patients with congenital heart disease (mean age: 7.95 ± 4.4 years) and 21 healthy subjects matched in age, gender, and socioeconomic status. IQ, motor skills, attention, behavior, and HRQL were evaluated due to the usage of validated psychological examination tests.

Results: The IQ was evaluated by using the Culture Fair Intelligence Test 1-R (CFT 1-R) for an age up to 9.5 years, while CFT 20-R was used starting from an age of 9.6 years. Around 95% of the patients who underwent ASCP had an IQ of more than 85 (normal range: 85–115). Nevertheless, the IQ scores significantly lower compared with the results of the healthy subjects. The IQ was neither associated with the duration of ASCP (p = 0.776) nor with an older age at surgery (p = 0.751). Lower parental socioeconomic status and lower HRQL were predictors for weaker outcomes in the IQ test. Motor skills were measured by using the Movement Assessment Battery for Children-2 test which revealed lower scores in every dimension: full scale, manual dexterity, ball skills, and balance (37 ± 50; 37 ± 48.8; 37 ± 63; and 43.5 ± 38) in distinction to healthy subjects (84 ± 37, p = 0.001; 63 ± 47; p = 0.011; 75 ± 57.5; p = 0.035; and 63 ± 35; p = 0.001).The scores in the full scale and balance dimensions were significantly lower than the peer group. The d2-test was used for the detection of selective attention problems but failed to identify differences between both groups. The analysis of the behavior displayed even a higher frequency of social (9.52%) and attention problems than in the peer group. Patients and their parents reported an overall satisfactory HRQL. Nevertheless, their scores were lower than healthy subjects. The neurological investigation found minor abnormalities in 14% of operated patients.

Conclusion: This study reflected that children who underwent neonatal/infantile cardiac surgery with ASCP have a satisfactory HRQL, while they showed an increased risk of cognitive disorders and motor deficits. Further preventive monitoring and follow-up strategies to detect neurocognitive difficulties and optimize the children’s development on an early stage may be required.