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. 2023 Mar 23:11:1003585.
doi: 10.3389/fped.2023.1003585. eCollection 2023.

Impact of cardiac surgical timing on the neurodevelopmental outcomes of newborns with Complex congenital heart disease (CHD)

Marien Lenoir  1 , Thibault Beretti  2 , Benoit Testud  3   4 , Noémie Resseguier  5 , Kim Gauthier  6 , Virginie Fouilloux  1 , Célia Gran  1 , Florent Paoli  7 , Fedoua El-Louali  7 , Philippe Aldebert  7 , Julie Blanc  7 , Camille Soulatges  7 , Sarab Al-Dybiat  7 , Guillaume Carles  7 , Chloe Wanert  7 , William Rozalen  6 , Stéphane Lebel  8 , Sophie Arnaud  8 , Dominique Santelli  8 , Chloé Allary  8 , Marianne Peyre  8 , Isabelle Grandvuillemin  9 , Clotilde Desroberts  9 , Myriem Belghiti Alaoui  8 , Farid Boubred  9 , Fabrice Michel  8 , Caroline Ovaert  7 , Mathieu Milh  6 , Clément François  10 , Béatrice Desnous  2   11
Affiliations

Impact of cardiac surgical timing on the neurodevelopmental outcomes of newborns with Complex congenital heart disease (CHD)

Marien Lenoir et al. Front Pediatr. .

Abstract

Background: More than half of infants with complex congenital heart disease (CHD) will have a neurodevelopmental disorder of multifactorial causes. The preoperative period represents a time-window during which neonates with complex CHD are in a state of hypoxia and hemodynamic instability, which fosters the emergence of brain injuries and, thus, affects early brain networks and neurodevelopmental outcomes. Currently, there is no consensus regarding the optimal age for cardiac surgery in terms of neurodevelopmental outcomes, and its definition is a real challenge. Our aim is to determine the relationship between cardiac surgical timing and long-term neurodevelopmental outcomes for various types of complex CHD.

Methods: We hypothesize that earlier surgical timing could represent a neuroprotective strategy that reduces perioperative white matter injuries (WMIs) and postoperative morbidity, leading to improved neurodevelopmental outcomes in infants with complex CHD. Firstly, our prospective study will allow us to determine the correlation between age at the time of surgery (days of life) and neurodevelopmental outcomes at 24 months. We will then analyze the correlation between age at surgery and (i) the incidence of WMIs (through pre- and postoperative MRIs), (ii) postoperative morbidity, and (iii) the duration of the hospital stay.

Implications and dissemination: This research protocol was registered in the Clinical Trial Registry (National Clinical Trial: NCT04733378). This project aims to help launch the first Neurocardiac Investigation Clinic in Marseille - AP-HM - to propose an overall personalized monitoring and treatment program for patients operated on for complex CHD.

Keywords: bayley IV; cardiac surgical timing; congenital heart disease; neonates; neurodevetlopmental outcomes; white matter injuries.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
24-month monitoring of patients born with CCHD operated on within the first 2 months of life. CPB, Cardiopulmonary bypass; CHD, Congenital Heart Disease; MRI, Magnetic Resonance Imaging; AIMS, Alberta Infant Motor scale; BAYLEY scale fourth edition.
See this image and copyright information in PMC

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