In children with severe heart defect, surgical management has little effect on neurodevelopmental outcomes

Children born with hypoplastic left-heart syndrome (HLHS) and related single-ventricle defects are vulnerable to developmental impairments, and variations in heart shunts and in cardiopulmonary bypass might affect outcomes of surgery. A Single-Ventricle Reconstruction (SVR) trial, sponsored by the National Heart, Lung and Blood Institute, is the largest prospective study of children undergoing the Norwood procedure, the first in a series of three staged surgeries used for this heart defect, using either the Blalock-Taussig shunt or the right-ventricular-to-pulmonary artery (RV-to-PA) shunt. However, neurodevelopmental delay remained common in both groups, a finding that was “discouragingly similar” to results from earlier studies, said J. William Gaynor, senior author of the study. Researchers suggested evaluating further measures to protect the brain from hemodynamic instability before and after the surgery, and improving developmental support after the infant is discharged.