Meena Nathan1, Anjali Sadhwani2, Kimberlee Gauvreau3, Michael Agus4, Janice Ware2, Jane W Newburger5, Frank Pigula6. 1. Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass. Electronic address: meena.nathan@cardio.chboston.org. 2. Cardiac Neurodevelopmental Program, Boston Children's Hospital and Harvard Medical School, Boston, Mass. 3. Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Mass. 4. Medicine Critical Care Program, Boston Children's Hospital and Harvard Medical School, Boston, Mass. 5. Cardiac Neurodevelopmental Program, Boston Children's Hospital and Harvard Medical School, Boston, Mass; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Mass. 6. Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass; Cardiac Neurodevelopmental Program, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
Abstract
OBJECTIVES: Technical Performance Score (TPS) has been shown to have a strong association with early and late outcomes after congenital cardiac surgery, with greater morbidity and reintervention in children with major residual lesions (TPS class 3). We sought to explore the effect of TPS on the neurodevelopmental outcomes. METHODS: All infants undergoing cardiac surgery, excluding those with trisomy 21, were offered neurodevelopmental testing at 1 year of age using the Bayley Scales of Infant Development, 3rd edition. TPSs from the discharge echocardiograms were graded as class 1 (optimal), class 2 (minor residual), or class 3 (major residual). Multivariate regression analysis was performed using patient characteristics and preoperative variables. RESULTS: Neurodevelopmental testing was performed in 140 patients at a median age of 16 months. Of these, 28 (20%) had single ventricle palliation; 39 (28%) were in Risk Adjustment for Congenital Heart Surgery category 4 to 6. Significant differences between the groups were found in the cognitive (P = .01) and motor (P = .05) domains, with subjects in TPS class 3 having significantly lower cognitive and motor composite scores. The scores did not vary significantly according to single ventricle versus biventricular repair or Risk Adjustment for Congenital Heart Surgery categorization. In multivariate modeling, class 3 TPS remained significantly associated with a lower Bayley cognitive score (P = .02), with a trend toward a lower Bayley motor score (P = .08). CONCLUSIONS: We found that TPS is an independent predictor of neurodevelopmental outcomes after infant heart surgery. Future research should explore whether a structured program of intraoperative recognition and intervention on residual lesions can improve the TPS and neurodevelopmental outcomes.
OBJECTIVES: Technical Performance Score (TPS) has been shown to have a strong association with early and late outcomes after congenital cardiac surgery, with greater morbidity and reintervention in children with major residual lesions (TPS class 3). We sought to explore the effect of TPS on the neurodevelopmental outcomes. METHODS: All infants undergoing cardiac surgery, excluding those with trisomy 21, were offered neurodevelopmental testing at 1 year of age using the Bayley Scales of Infant Development, 3rd edition. TPSs from the discharge echocardiograms were graded as class 1 (optimal), class 2 (minor residual), or class 3 (major residual). Multivariate regression analysis was performed using patient characteristics and preoperative variables. RESULTS: Neurodevelopmental testing was performed in 140 patients at a median age of 16 months. Of these, 28 (20%) had single ventricle palliation; 39 (28%) were in Risk Adjustment for Congenital Heart Surgery category 4 to 6. Significant differences between the groups were found in the cognitive (P = .01) and motor (P = .05) domains, with subjects in TPS class 3 having significantly lower cognitive and motor composite scores. The scores did not vary significantly according to single ventricle versus biventricular repair or Risk Adjustment for Congenital Heart Surgery categorization. In multivariate modeling, class 3 TPS remained significantly associated with a lower Bayley cognitive score (P = .02), with a trend toward a lower Bayley motor score (P = .08). CONCLUSIONS: We found that TPS is an independent predictor of neurodevelopmental outcomes after infant heart surgery. Future research should explore whether a structured program of intraoperative recognition and intervention on residual lesions can improve the TPS and neurodevelopmental outcomes.
Authors: Anitha Parthiban; Jami C Levine; Meena Nathan; Jennifer A Marshall; Girish S Shirali; Stephen D Simon; Steve D Colan; Jane W Newburger; Geetha Raghuveer Journal: Pediatr Cardiol Date: 2015-09-10 Impact factor: 1.655
Authors: Meena Nathan; Felicia L Trachtenberg; Maria I Van Rompay; William Gaynor; Kirk Kanter; Richard Ohye; Emile A Bacha; James Tweddell; Steven M Schwartz; L LuAnn Minich; Carlos M Mery; Steven D Colan; Jami Levine; Linda M Lambert; Jane W Newburger Journal: J Thorac Cardiovasc Surg Date: 2019-11-15 Impact factor: 5.209
Authors: Meena Nathan; Lynn A Sleeper; Richard G Ohye; Peter C Frommelt; Christopher A Caldarone; James S Tweddell; Minmin Lu; Gail D Pearson; J William Gaynor; Christian Pizarro; Ismee A Williams; Steven D Colan; Carolyn Dunbar-Masterson; Peter J Gruber; Kevin Hill; Jennifer Hirsch-Romano; Jeffrey P Jacobs; Jonathan R Kaltman; S Ram Kumar; David Morales; Scott M Bradley; Kirk Kanter; Jane W Newburger Journal: J Thorac Cardiovasc Surg Date: 2014-06-19 Impact factor: 5.209
Authors: Meena Nathan; Jami C Levine; Maria I Van Rompay; Linda M Lambert; Felicia L Trachtenberg; Steven D Colan; Iki Adachi; Brett R Anderson; Emile A Bacha; Aaron Eckhauser; J William Gaynor; Eric M Graham; Benjamin Goot; Jeffrey P Jacobs; Rija John; Jonathan R Kaltman; Kirk R Kanter; Carlos M Mery; L LuAnn Minich; Richard Ohye; David Overman; Christian Pizarro; Geetha Raghuveer; Marcus S Schamberger; Steven M Schwartz; Shanthi L Narasimhan; Michael D Taylor; Ke Wang; Jane W Newburger Journal: J Am Coll Cardiol Date: 2021-05-18 Impact factor: 24.094
Authors: Ana Ubeda Tikkanen; Meena Nathan; Lynn A Sleeper; Marisa Flavin; Ana Lewis; Donna Nimec; John E Mayer; Pedro Del Nido Journal: J Am Heart Assoc Date: 2018-05-12 Impact factor: 5.501
Authors: Jo Wray; Deborah Ridout; Alison Jones; Peter Davis; Paul Wellman; Warren Rodrigues; Emma Hudson; Victor Tsang; Christina Pagel; Katherine L Brown Journal: Ann Thorac Surg Date: 2020-11-27 Impact factor: 4.330