University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA.
Curr Opin Cardiol. 2012 Mar;27(2):82-91. doi: 10.1097/HCO.0b013e328350197b.
The present review focuses on neurodevelopmental and neuropsychologic outcomes following neonatal and infant heart surgery for complex congenital heart lesions. The data include recent reports on perioperative MRI and recent results of randomized clinical trials addressing perioperative variables.
Advancements in magnetic resonance techniques have reinforced earlier data that newborns with complex congenital heart lesions are frequently born with brain immaturity. Randomized clinical trials have looked at several important perioperative candidate predictors as potential independent risk factors for worsened neurodevelopmental outcomes: no difference was found between regional cerebral perfusion and deep hypothermic circulatory arrest on 1-year outcomes; no difference was found between the modified Blalock-Taussig shunt and the right ventricular to pulmonary artery shunt as part of the Norwood procedure on 14-month outcomes; at 16-year testing for individuals with transposition of the great arteries following the arterial switch operation, no significant difference was found between low-flow cardiopulmonary bypass and deep hypothermic circulatory arrest.
Randomized clinical, cross-sectional, and prospective trials have explored robust analyses looking for independent risk factors for worsened neurodevelopmental outcomes. Most of these risk factors are patient-related or socioeconomic, with only a few potentially modifiable.
本综述重点关注新生儿和婴儿复杂先天性心脏病变心脏手术后的神经发育和神经心理学结果。这些数据包括关于围手术期 MRI 的最新报告以及解决围手术期变量的随机临床试验的最新结果。
磁共振技术的进步强化了早期数据，即患有复杂先天性心脏病变的新生儿通常出生时大脑不成熟。随机临床试验研究了几个重要的围手术期候选预测因素，作为神经发育不良结果的潜在独立危险因素：区域脑灌注与深低温循环停止在 1 年结果方面没有差异；在 Norwood 手术中，改良 Blalock-Taussig 分流术和右心室肺动脉分流术作为一部分，在 14 个月的结果方面没有差异；大动脉转位患者在动脉切换手术后 16 年的测试中，低流量体外循环与深低温循环停止之间没有显著差异。
随机临床试验、横断面和前瞻性试验探索了寻找神经发育不良结果恶化的独立危险因素的稳健分析。这些危险因素大多数与患者相关或与社会经济有关，只有少数是潜在可改变的。
