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Review
. 2012 Dec;44(4):216-23.

Improvements in survival and neurodevelopmental outcomes in surgical treatment of hypoplastic left heart syndrome: a meta-analytic review

Joseph J Sistino  1 , Heather Shaw Bonilha
Affiliations
Review

Improvements in survival and neurodevelopmental outcomes in surgical treatment of hypoplastic left heart syndrome: a meta-analytic review

Joseph J Sistino et al. J Extra Corpor Technol. 2012 Dec.

Abstract

The purpose of this study was to analyze the changes over the past two decades in hospital survival and neurodevelopmental outcomes after surgical treatment for hypoplastic left heart syndrome. The hypothesis for this study is that increasing hospital survival following the Stage I Norwood (S1N) procedure is associated with improvements in neurodevelopmental outcomes. Studies included in the meta-analysis were identified by searching Ovid MEDLINE from January 1980 to October 2010. A total of 72 articles were identified. Fifteen single-center study articles were appropriate for obtaining survival data and 14 were used for neurodevelopmental outcomes. Wechsler Intelligence Test IQ scores and the Bayley II Mental Development (MDI) and Psychomotor Development Indices (PDI) were the primary neurodevelopmental outcomes included in this meta-analysis. Metaregression analysis using a mixed-effects model compared the percent survival and neurodevelopmental scores with the year of surgery. Hospital survival for the S1N operation increased significantly from 1996 to 2007 (p < .05). The overall mean survival during this time period was 80.05% (95% confidence interval [CI], 76.4-84.0%). Standardized Wechsler IQ scores increased significantly from 1989 to 1999 (p < .05) and the mean IQ was 85.09 (95% CI, 82.3-89.5). The Bayley II MDI increased significantly from 1998 to 2005 (p < .05) with a mean MDI of 86.9 (95% CI, 84.9-88.9). The Bayley II PDI increased significantly from 1998 to 2005 (p < .05) with a mean PDI of 73.4 (95% CI, 71.2-75.5). Increased survival has been associated with improved but below normal neurodevelopmental outcomes.

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Conflict of interest statement

The senior author has stated that authors have reported no material, financial, or other relationship with any healthcare-related business or other entity whose products or services are discussed in this paper.

Figures

Figure 1.
Figure 1.
Hospital survival after Stage I Norwood from 1996–2007 and 95% confidence intervals. Subgroup analysis includes: modified Blalock-Taussig shunt (MBTS) vs. right ventricular to pulmonary artery (RVPA) conduit.
Figure 2.
Figure 2.
Hospital survival following Stage I Norwood significantly increased from 1996–2007 (p < .05) (15 studies). Circle sizes are proportional to the study sample sizes.
Figure 3.
Figure 3.
Mean IQ after Stage I Norwood from 1989–1999 and 95% confidence intervals.
Figure 4.
Figure 4.
Mean IQ after Stage I Norwood significantly increased from 1989 to 1999 (p < .05). Circle sizes are proportional to the study sample sizes.
Figure 5.
Figure 5.
Bayley II Mental Development Index (MDI) after Stage 1 Norwood from 1998–2005 and confidence intervals.
Figure 6.
Figure 6.
Bayley II Mental Development Index (MDI) after Stage 1 Norwood significantly increased from 1998–2005 (p < .05). Circle sizes are proportional to the study sample sizes.
Figure 7.
Figure 7.
Bayley II Psychomotor Development Index (PSI) after Stage 1 Norwood from 1998–2005 and confidence intervals.
Figure 8.
Figure 8.
Bayley II Psychomotor Development Index (PSI) after Stage 1 Norwood significantly increased from 1998–2005 (p < .05). Circle sizes are proportional to the study sample sizes.
See this image and copyright information in PMC

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