Mahle William T, Lundine Karen, Kanter Kirk R, Forbess Joseph M, Kirshbom Paul, Tosone Steven R, Vincent Robert N
Department of Pediatrics, Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road, NE, Atlanta, GA 30322-1062, USA.
Eur J Cardiothorac Surg. 2004 Nov;26(5):920-5. doi: 10.1016/j.ejcts.2004.08.008.
Cognitive deficits are common in adults following surgery utilizing cardiopulmonary bypass (CPB). A previous retrospective study suggested that surgical closure of an ASD in children was associated with neurologic injury, while transcather therapy was not. In a prospective study, we sought to determine whether neurologic deficits occur following repair of non-complex congenital heart lesions in school-age children and young adults.
Inclusion criteria were: age between 5 and 20 years, cardiac surgery utilizing CPB without deep hypothermic circulatory arrest, and no prior cardiac surgery. Patients underwent psychometric testing 1-3 days prior to surgery and re-evaluation 7-18 days after surgery. In order to determine the test/re-test effect an age-matched cohort of children undergoing transcather closure of ASD under general anesthesia was also evaluated. The primary outcome measures were verbal and picture memory. Additional psychometric tests included: computerized performance test (CPT) and Digit Span (DS). Forty-one patients were enrolled, 29 undergoing surgery with CPB and 12 controls. Surgical procedures included ASD closure (n=13), VSD closure (n=10), resection of sub-aortic stenosis (n=3), mitral valvuloplasty (n=3). Mild hypothermia was used in all cases. The mean duration of CPB was 54+/-22 min.
There was no significant difference in any of the psychometric test scores between subjects undergoing surgery with CPB or controls.
There are no marked adverse neurologic effects of CPB in school-age children and young adults undergoing non-complex open-heart surgery. These data are important in counseling patients and families and should be considered in the debate as to the relative merits of transcather versus open-heart repair of various heart lesions.
认知缺陷在接受体外循环（CPB）手术的成人中很常见。先前的一项回顾性研究表明，儿童房间隔缺损（ASD）的手术闭合与神经损伤有关，而经导管治疗则不然。在一项前瞻性研究中，我们试图确定学龄儿童和年轻成人在修复非复杂性先天性心脏病变后是否会出现神经功能缺损。
纳入标准为：年龄在5至20岁之间，接受使用CPB且无深度低温循环停止的心脏手术，且此前未接受过心脏手术。患者在手术前1 - 3天接受心理测量测试，并在手术后7 - 18天进行重新评估。为了确定测试/复测效应，还对一组在全身麻醉下接受ASD经导管闭合的年龄匹配儿童队列进行了评估。主要结局指标是言语和图像记忆。其他心理测量测试包括：计算机化执行测试（CPT）和数字广度（DS）。共纳入41例患者，其中29例接受CPB手术，12例为对照组。手术包括ASD闭合（n = 13）、室间隔缺损（VSD）闭合（n = 10）、主动脉瓣下狭窄切除术（n = 3）、二尖瓣成形术（n = 3）。所有病例均采用轻度低温。CPB的平均持续时间为54±22分钟。
接受CPB手术的受试者与对照组之间在任何心理测量测试分数上均无显著差异。
在接受非复杂性心脏直视手术的学龄儿童和年轻成人中，CPB没有明显的不良神经影响。这些数据对于向患者及其家属提供咨询很重要，并且在关于经导管治疗与各种心脏病变的心脏直视修复的相对优点的辩论中应予以考虑。
