Risk factors for adverse neurocognitive outcomes in school-aged patients after the Fontan operation
OBJECTIVES: As the surgical results for Fontan candidates improve, much attention has been given to the long-term cognitive outcomes. This study aimed to assess the neurocognitive outcomes after Fontan completion, and to determine the factors associated with an extremely low intelligence quotient (IQ <70).
METHODS: A total of 70 local eligible school-aged patients were enrolled in the study (hypoplastic left heart syndrome, 17; right atrial isomerism, 15 and others, 38). Fontan operations were performed at a median age of 1.8 (range, 0.5-8.9) years (primary Fontan, 4 of 70 [6%]). The Wechsler Intelligence Test was taken at a median age of 9 (range, 5.1-14.4) years for the purpose of neurocognitive evaluation. Patients' data were collected from medical records, and a retrospective analysis of potential predictors for an IQ <70 was performed.
RESULTS: The median full-scale IQ (FSIQ) for the entire cohort was 85 (range, 43-118). Of the lower order composites, the perceptual reasoning index and the working memory index were significantly lower in low-FSIQ patients (P < 0.05). Overall, 15 of 70 (21%) of the cohort had an IQ <70. Univariate analysis identified three significant risk factors for FSIQ <70 (15 of 70, 21%): body weight <2.5 kg at initial palliative surgery (P < 0.05), low 5-min Apgar score <4 (P < 0.05) and inter-stage events requiring cardiopulmonary resuscitation (CPR) (P < 0.05). No other patient-specific factors (e.g. cardiac morphology) or modifiable surgical factors (e.g. the use of hypothermic cardiac arrest) were associated with FSIQ <70.
CONCLUSIONS: Low body weight (<2.5 kg) at initial operation, low 5-min Apgar score (<4) and inter-stage CPR were significant risk factors for impaired neurocognitive outcomes. An evolving strategy for preventing inter-stage CPR may improve cognitive outcomes.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2013 |
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| Erschienen: |
2013 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:44 |
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| Enthalten in: |
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery - 44(2013), 3 vom: 21. Sept., Seite 454-61; discussion 461 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Sugimoto, Ai [VerfasserIn] |
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| Links: |
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| Themen: |
Adverse effects |
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| Anmerkungen: |
Date Completed 09.05.2014 Date Revised 15.08.2013 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1093/ejcts/ezt062 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM225163160 |
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| 245 | 1 | 0 | |a Risk factors for adverse neurocognitive outcomes in school-aged patients after the Fontan operation |
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| 500 | |a Date Revised 15.08.2013 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVES: As the surgical results for Fontan candidates improve, much attention has been given to the long-term cognitive outcomes. This study aimed to assess the neurocognitive outcomes after Fontan completion, and to determine the factors associated with an extremely low intelligence quotient (IQ <70) | ||
| 520 | |a METHODS: A total of 70 local eligible school-aged patients were enrolled in the study (hypoplastic left heart syndrome, 17; right atrial isomerism, 15 and others, 38). Fontan operations were performed at a median age of 1.8 (range, 0.5-8.9) years (primary Fontan, 4 of 70 [6%]). The Wechsler Intelligence Test was taken at a median age of 9 (range, 5.1-14.4) years for the purpose of neurocognitive evaluation. Patients' data were collected from medical records, and a retrospective analysis of potential predictors for an IQ <70 was performed | ||
| 520 | |a RESULTS: The median full-scale IQ (FSIQ) for the entire cohort was 85 (range, 43-118). Of the lower order composites, the perceptual reasoning index and the working memory index were significantly lower in low-FSIQ patients (P < 0.05). Overall, 15 of 70 (21%) of the cohort had an IQ <70. Univariate analysis identified three significant risk factors for FSIQ <70 (15 of 70, 21%): body weight <2.5 kg at initial palliative surgery (P < 0.05), low 5-min Apgar score <4 (P < 0.05) and inter-stage events requiring cardiopulmonary resuscitation (CPR) (P < 0.05). No other patient-specific factors (e.g. cardiac morphology) or modifiable surgical factors (e.g. the use of hypothermic cardiac arrest) were associated with FSIQ <70 | ||
| 520 | |a CONCLUSIONS: Low body weight (<2.5 kg) at initial operation, low 5-min Apgar score (<4) and inter-stage CPR were significant risk factors for impaired neurocognitive outcomes. An evolving strategy for preventing inter-stage CPR may improve cognitive outcomes | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Adverse effects | |
| 650 | 4 | |a Fontan procedure | |
| 650 | 4 | |a Hypoplastic left heart syndrome | |
| 650 | 4 | |a Intelligence tests | |
| 650 | 4 | |a Neurobehavioural manifestations | |
| 650 | 4 | |a Right atrial isomerism | |
| 700 | 1 | |a Ota, Noritaka |e verfasserin |4 aut | |
| 700 | 1 | |a Ibuki, Keijiro |e verfasserin |4 aut | |
| 700 | 1 | |a Miyakoshi, Chisato |e verfasserin |4 aut | |
| 700 | 1 | |a Murata, Masaya |e verfasserin |4 aut | |
| 700 | 1 | |a Tosaka, Yuko |e verfasserin |4 aut | |
| 700 | 1 | |a Yamazaki, Toru |e verfasserin |4 aut | |
| 700 | 1 | |a Sakamoto, Kisaburo |e verfasserin |4 aut | |
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