Developmental outcome after surgical versus interventional closure of secundum atrial septal defect in children

Background-The assessment of the impact of cardiopulmonary bypass (CPB) on developmental outcomes in children who undergo open heart surgery is hamper ed by the absence of a suitable comparison group. The development of interv entional catheterization techniques for the repair of certain types of cong enital heart lesions provides the opportunity to study children who have no t been exposed to CPB. Methods and Results-We performed standardized neuropsychological testing on children after closure of a secundum atrial septal defect through the use of surgery (n=26) or a transcatheter device (n=19). Device patients, compar ed with surgical patients, were similar in age at defect closure (mean, 6 y ears) but older at follow-up testing (12.3 versus 10.6 years). The mean wei ght percentile at closure was greater and the defect size was smaller in th e device patients. Families of device patients tended to have a higher pare nt IQ, higher level of maternal education, and higher level of maternal occ upation. In general, however, children's IQ and achievement scores were in the normal range for both groups. In regression analyses with adjustment fo r age at testing and parent IQ, surgical repair was associated with a 9.5-p oint deficit in Full-Scale IQ (P=0.03) and a 9.7-point deficit in Performan ce IQ (P=0.05), Flock Design was the IQ subtest on which treatment groups d iffered the most (P=0.01). Surgical patients achieved significantly better scores on errors of commission (P=0.05) and attentiveness index (P=0.03) on a continuous performance test of attention, Scores on tests of achievement and other neuropsychological domains did not differ significantly between the groups. Regression analyses within the surgical group failed to identif y significant CPB-related risk factors. Conclusions-A prospective randomized trial or a study that includes prerepa ir and postrepair assessments is necessary to establish whether the observe d advantages of device closure in neuropsychological outcome represent dele terious effects of CPB or a methodological artifact.