Postoperative neurodevelopmental outcomes of end-to-side anastomosis for coarctation of the aorta

doi:10.3969/j.issn.1674-8115.2025.06.010

Abstract

Abstract:

Objective ·To analyze the neurodevelopmental outcomes of children after end-to-side anastomosis for coarctation of the aorta (CoA). Methods ·The surgical and neurological follow-up data were collected from children who underwent end-to-side anastomosis for CoA at Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine from January 1, 2017 to December 31, 2021. Neurological assessments included magnetic resonance imaging (MRI) and Griffiths Mental Development Scale assessments. Neurodevelopmental outcomes were evaluated using Griffiths Mental Development Scale. Clinical characteristics were compared between patients with normal and abnormal MRI and Griffiths Mental Development Scale results to assess the correlation between the two assessments and their association with cardiopulmonary bypass (CPB) use and CPB modality. Results ·Twenty-seven children with isolated CoA or CoA combined with simple intracardiac anomalies were included. MRI results were available for 25 cases, with 5 showing abnormalities (20.0%). Griffiths Mental Development Scale results were available for 26 cases, with 21 (80.77%) showing abnormal scores, including 18 in hearing and language, and 12 in performance. No significant correlation was found between abnormal MRI or Griffiths Mental Development Scale results and the use of CPB (P=0.341, P=1.000). Among patients who underwent CPB, those in the moderate hypothermia group accounted for the majority of cases without neurological abnormalities, with proportions of 80.00% (MRI) and 100.00% (Griffiths Mental Development Scale). Conclusion ·Children undergone end-to-side anastomosis for CoA are at relatively high risk for neurodevelopmental abnormalities, particularly in hearing-language and performance domains. CPB may not be a direct risk factor for poor neurodevelopmental outcome, and moderate hypothermia during CPB may be neuroprotective.

Key words: coarctation of the aorta (CoA), magnetic resonance imaging (MRI), cardiopulmonary bypass (CPB), neurodevelopmental outcome, Griffiths Mental Development Scale

CLC Number:

R726.1

LI Zhuohang, YU Xindi, REN Jingya, SHEN Jia, DONG Suzhen, WANG Wei. Postoperative neurodevelopmental outcomes of end-to-side anastomosis for coarctation of the aorta[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(6): 753-759.

Figures/Tables 5

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References 14

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Item	All (n=27)	Non-CPB group (n=11)	CPB group (n=16)	t/z value	P value
Age at surgery /d	127.00 (32.00, 187.00)	127.00 (32.00, 187.00)	87.00 (21.25, 146.25)	-1.629	0.103
Weight at surgery/kg	5.000 (4.280, 6.800)	6.361±2.943	4.750 (4.145, 6.025)	-1.037	0.300
Age at examination /d	745.78±236.33	799.09±152.64	709.13±278.86	0.971	0.341
Surgery time/min	153.89±58.35	97.27±31.81	192.81±35.50	-7.160	<0.001
Number of cases with normal MRI results/n	20	10	10	‒	0.341
Number of cases with abnormal MRI results/n	5	1	4	‒	0.341
Number of cases with normal Griffiths Mental Development Scale results/n	5	2	3	‒	1.000
Number of cases with abnormal Griffiths Mental Development Scale results/n	21	8	13	‒	1.000

Item	All (n=27)	Non-CPB group (n=11)	CPB group (n=16)	t/z value	P value
Age at surgery /d	127.00 (32.00, 187.00)	127.00 (32.00, 187.00)	87.00 (21.25, 146.25)	-1.629	0.103
Weight at surgery/kg	5.000 (4.280, 6.800)	6.361±2.943	4.750 (4.145, 6.025)	-1.037	0.300
Age at examination /d	745.78±236.33	799.09±152.64	709.13±278.86	0.971	0.341
Surgery time/min	153.89±58.35	97.27±31.81	192.81±35.50	-7.160	<0.001
Number of cases with normal MRI results/n	20	10	10	‒	0.341
Number of cases with abnormal MRI results/n	5	1	4	‒	0.341
Number of cases with normal Griffiths Mental Development Scale results/n	5	2	3	‒	1.000
Number of cases with abnormal Griffiths Mental Development Scale results/n	21	8	13	‒	1.000

Item	All (n=25)	Abnormal MRI result group (n=5)	Normal MRI result group (n=20)	t/z value	P value
Age at surgery/d	127.00 (30.50, 190.50)	105.20±100.64	131.00 (38.50, 192.25)	-0.747	0.455
Weight at surgery/kg	5.000 (4.340, 6.750)	4.793±1.173	5.150 (4.310, 6.950)	-0.917	0.359
Age at examination /d	774.16±221.75	806.00±301.61	766.20±206.47	-0.352	0.728
Surgery time/min	148.40±57.13	156.00±40.68	146.50±61.28	-0.326	0.747
Number of cases with CPB/n	14	4	10
CPB time/min	96.29±30.77	69.75±22.60	106.90±27.55	2.378	0.035
HCT during CPB/%	24.71±2.16	24.75±2.06	24.70±2.31	-0.038	0.971
Number of cases with aortic cross-clamp/n	13	3	10
Aortic clamp time/min	56.23±16.70	44.67±13.32	59.70±16.57	1.425	0.182
Number of cases with circulatory arrest/n	5	1	4
Duration of circulatory arrest/min	24.80±6.42	21	25.75±6.99
Number of cases with cerebral perfusion/n	4	0	4
Duration of cerebral perfusion/min	30.00±6.58	‒	30.00±6.58

Item	All (n=25)	Abnormal MRI result group (n=5)	Normal MRI result group (n=20)	t/z value	P value
Age at surgery/d	127.00 (30.50, 190.50)	105.20±100.64	131.00 (38.50, 192.25)	-0.747	0.455
Weight at surgery/kg	5.000 (4.340, 6.750)	4.793±1.173	5.150 (4.310, 6.950)	-0.917	0.359
Age at examination /d	774.16±221.75	806.00±301.61	766.20±206.47	-0.352	0.728
Surgery time/min	148.40±57.13	156.00±40.68	146.50±61.28	-0.326	0.747
Number of cases with CPB/n	14	4	10
CPB time/min	96.29±30.77	69.75±22.60	106.90±27.55	2.378	0.035
HCT during CPB/%	24.71±2.16	24.75±2.06	24.70±2.31	-0.038	0.971
Number of cases with aortic cross-clamp/n	13	3	10
Aortic clamp time/min	56.23±16.70	44.67±13.32	59.70±16.57	1.425	0.182
Number of cases with circulatory arrest/n	5	1	4
Duration of circulatory arrest/min	24.80±6.42	21	25.75±6.99
Number of cases with cerebral perfusion/n	4	0	4
Duration of cerebral perfusion/min	30.00±6.58	‒	30.00±6.58

Item	All (n=26)	Abnormal Griffiths Mental Development Scale result group (n=21)	Normal Griffiths Mental Development Scale result group (n=5)	t/z value	P value
Age at surgery /d	116.00 (31.25, 188.75)	127.00 (34.00, 190.50)	119.40±125.23	-4.888	0.626
Weight at surgery/kg	5.000 (4.235, 6.850)	5.000 (4.250, 6.750)	6.008±2.822	0.000	1.000
Age at examination/d	737.12±236.60	741.33±253.17	719.40±170.06	-0.183	0.857
Surgery time/min	157.12±57.00	156.19±56.59	161.00±65.33	0.166	0.869
Number of cases with CPB/n	16	13	3
CPB time/min	99.00±30.16	93.46±28.35	123.00±30.61	1.608	0.130
HCT during CPB/%	24.56±2.13	24.46±2.22	25.00±2.00	0.384	0.707
Number of cases with aortic cross-clamp/n	15	12	3
Aortic clamp time/min	57.40±15.88	53.25±13.25	74.00±16.82	2.320	0.037
Number of cases with circulatory arrest/n	5	4	1
Duration of circulatory arrest/min	24.80±6.42	24.25±7.27	27.00
Number of cases with cerebral perfusion/n	6	5	1
Duration of cerebral perfusion/min	30.17±5.19	31.60±4.28	23.00