Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass

Background-It is not known whether developmental and neurological outcomes in the preschool period differ depending on whether the predominant vital o rgan support strategy used in infant heart surgery was total circulatory ar rest (CA) or low-flow cardiopulmonary bypass. Methods and Results Infants with D-transposition of the great arteries who underwent an arterial-switch operation were randomly assigned to a support method consisting predominantly of CA or low-now cardiopulmonary bypass. De velopmental and neurological status were evaluated blindly at 4 years of ag e in 158 of 163 eligible children (97%). Neither IQ scores nor overall neur ological status were significantly associated with either treatment group o r duration of CA. The CA group scored lower on tests of motor function (gro ss motor, P=0.01; fine motor, P=0.03) and bad more severe speech abnormalit ies (oromotor apraxia, P=0.007). Seizures in the perioperative period, dete cted either clinically or by continuous electroencephalograpbic monitoring, were associated with lower mean IQ scores (12.6 and 7.7 points, respective ly) and increased risk of neurological abnormalities (odds ratios, 8.4 and 5.6, respectively). The performance. of the full cohort was below expectati ons in several domains, including IQ, expressive language, visual-motor int egration, motor function, and oromotor control. Conclusions-Use of CA to support vital organs during open heart surgery in infancy is associated, at, the age of 4 years, with worse motor coordinatio n and planning but not with lower IQ or with worse overall neurological sta tus,