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In children born with severe heart defect, surgical management has little effect on neuro outcomes
Date:4/5/2012

In the largest multicenter clinical trial of children undergoing early-stage surgery for single-ventricle heart defects, differences in intraoperative management did not significantly affect neurodevelopmental outcomes at 14 months of age. Instead, the strongest influences were innate patient characteristics and general medical morbidity during the child's first year of life.

Children born with hypoplastic left-heart syndrome (HLHS) and related single-ventricle defects have long been known to be vulnerable to developmental impairments, and researchers suspected that variations in heart shunts and in cardiopulmonary bypass might affect outcomes. However, the study leaders concluded that substantial improvements in neurodevelopmental outcomes are "likely to require interventions that occur outside the operating room." For example, because infants delivered closer to term had better neurodevelopmental outcomes, the researchers suggest postponing elective delivery from 37 weeks to 39 or 40 weeks might benefit patients.

Researchers from 15 hospitals in the National Heart, Lung, and Blood Institute's Pediatric Heart Network published these results from the Single-Ventricle Reconstruction (SVR) trial online March 28 in the journal Circulation. The lead author was Jane W. Newburger, M.D., M.P.H., of Children's Hospital Boston.

The SVR trial, sponsored by the National Heart, Lung and Blood Institute, is the largest prospective study of children undergoing the Norwood procedure, the first in a series of three staged surgeries used for this complex, life-threatening heart defect. The trial compared outcomes after the Norwood procedure for two types of heart shunt: the Blalock-Taussig shunt and the right-ventricular-to-pulmonary artery (RV-to-PA) shunt. The current study reported on an important secondary trial outcome, neurodevelopment assessed at 14 months of age.

The study leaders hypothesized that children in the RV-to-PA sh
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Contact: Joey McCool Ryan
McCool@email.chop.edu
267-426-6070
Children's Hospital of Philadelphia
Source:Eurekalert

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