LONGTERM BEHAVIORAL OUTCOME AND QUALITY OF LIFE AFTER NEONATAL ARTERIAL SWITCH OPERATION IN NEONATES WITH TRANSPOSITION OF THE GREAT ARTERIES
 
Hövels-Gürich HH, Konrad K, Wiesner M, Herpertz-Dahlmann B, Messmer BJ, von
Bernuth G.
Departments of Paediatric Cardiology, Child and Adolescent Psychiatry, Thoracic and
Cardiovascular Surgery, University Hospital, RWTH Aachen, Aachen, Germany.
 
Background - Aims. Behavioral outcome and quality of life in children between 8 and 14 years of age after neonatal arterial switch operation for transposition of the great arteries has not yet been systematically evaluated and is the topic of the present work.
 
Methods. 60 unselected children operated as neonates with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass were evaluated at age 7.9 to 14.3 years (10.5,1.6; mean, standard deviation) by the Child Behavior Checklist (CBCL) to assess parent-reported behavioral problems and by the Inventory for the Assessment of the Quality of Life in Children and Adolescents (IQCL) to evaluate self-reported quality of life. Results were related to perioperative status and management, to current neurodevelopmental status, endurance capacity and sociodemographic factors.
 
Results. Behavioral outcome on all CBCL problem and competence scores was worse, whereas quality of life on IQCL scores was not generally reduced compared to the normal population. In multivariable analysis, severe preoperative hypoxia was related to parent-reported social problems; peri-and postoperative cardiocirculatory insufficiency was associated with internalizing, externalizing, attention and total behavioral problems. Reduced expressive language was also found associated with total behavioral problems, and poor academic achievement was related to parent-reported deficits in school performance. Impaired neurological status and reduced endurance capacity both predicted self-reported stress by illness.
 
Conclusions. The neonatal arterial switch operation with combined circulatory arrest and low flow bypass is associated with parent-reported longterm behavioral impairment, but not with self-reported general reduction in quality of life. Discrepancy between parental and self-reports may be due to different perception of illness. In our experience, increased risk of longterm psychosocial maladjustment after neonatal corrective cardiac surgery is related to the presence of neurological impairment and reduced endurance capacity.

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