What are the long-term neurologic effects and developmental concerns associated with Pumped (cardiopulmonary bypass) disease?

From the Guidelines

Children with congenital heart disease are at high risk for long-term neurologic effects and developmental concerns, and early identification and intervention are crucial to improve their quality of life and outcomes. The most recent evidence from the American Heart Association suggests that individuals who had cardiac surgery with cardiopulmonary bypass during infancy are at increased risk for neurodevelopmental disorders and disabilities 1. The use of cardiopulmonary bypass results in a hyperinflammatory response, an increased risk of microscopic and macroscopic emboli to the brain, and hypoperfusion resulting in global ischemia/reperfusion injury.

Key factors that affect neurodevelopmental outcomes in these patients include:

• The duration of deep hypothermic circulatory arrest (DHCA) during surgery, with durations exceeding 41 minutes associated with adverse effects 1
• The type of intraoperative management strategy, although this contributes less variance to neurodevelopmental outcomes than patient-specific and preoperative factors, perioperative hemodynamic instability, and postoperative morbidities 1
• The importance of early identification and intervention, as children with congenital heart disease may require habilitative services, including tutoring, special education, and physical, occupational, and speech therapy to reach their full potential 1

A multidisciplinary approach involving neurologists, cardiologists, physical therapists, speech therapists, and genetic counselors is essential for the management of children with congenital heart disease, and regular developmental assessments and early intervention services should be implemented to improve their outcomes. The severity of neurological and developmental impacts varies based on disease onset and how quickly treatment begins, with earlier treatment generally resulting in better developmental outcomes 1.

From the Research

Pumped Disease Neurologic Long Term Effects

• There is limited information available on the neurologic long term effects of pumped disease in the provided studies.
• However, it is known that heart failure can have significant effects on the brain and nervous system, including cognitive impairment and increased risk of stroke and dementia 2, 3, 4, 5, 6.

Developmental Concerns

• The provided studies do not specifically address developmental concerns related to pumped disease.
• However, it is known that heart failure can have significant effects on the development and growth of children, including delayed physical and cognitive development 2, 3, 4, 5, 6.
• Beta-blockers, which are commonly used to treat heart failure, have been shown to be safe and effective in children, but may have potential side effects such as growth restriction and developmental delays 5, 6.

Treatment and Management

• The treatment and management of pumped disease typically involve the use of medications such as beta-blockers, ACE inhibitors, and diuretics, as well as lifestyle modifications such as diet and exercise 2, 3, 4, 5, 6.
• Mechanical circulatory support devices, such as left ventricular assist devices, may also be used in advanced cases of heart failure 3, 4.
• The choice of treatment and management strategy will depend on the individual patient's needs and circumstances, and should be guided by a healthcare professional 2, 3, 4, 5, 6.