Cognitive and Executive Function in Congenital Heart Disease: A Meta-analysis

• Published in: Pediatrics (Evanston) Vol. 148; no. 4; p. 1
• Main Authors: Feldmann, Maria, Bataillard, Célina, Ehrler, Melanie, Ullrich, Cinzia, Knirsch, Walter, Gosteli-Peter, Martina A, Held, Ulrike, Latal, Beatrice
• Format: Journal Article
• Language: English
• Published: United States American Academy of Pediatrics 01.10.2021
• Subjects: Adolescent; Arteries; Cardiopulmonary Bypass; Cardiovascular disease; Child; Child, Preschool; Children; Cognition; Cognitive ability; Confidence intervals; Congenital diseases; Coronary artery disease; Executive Function; Heart Defects, Congenital - psychology; Heart Defects, Congenital - surgery; Heart diseases; Heart surgery; Humans; Intellectual Disability - etiology; Intelligence; Intelligence Tests; Meta-analysis; Pediatrics; Population studies; Risk factors; Septum; Transposition; Ventricle
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2021-050875

Cognitive function and executive function (EF) impairments contribute to the long-term burden of congenital heart disease (CHD). However, the degree and profile of impairments are insufficiently described. To systematically review and meta-analyze the evidence on cognitive function and EF outcomes in school-aged children operated for CHD and identify the risk factors for an unfavorable outcome. Cochrane, Embase, Medline, and PsycINFO. Original peer-reviewed studies reporting cognitive or EF outcome in 5- to 17-year old children with CHD after cardiopulmonary bypass surgery. Results of IQ and EF assessments were extracted, and estimates were transformed to means and SE. Standardized mean differences were calculated for comparison with healthy controls. Among 74 studies (3645 children with CHD) reporting total IQ, the summary estimate was 96.03 (95% confidence interval: 94.91 to 97.14). Hypoplastic left heart syndrome and univentricular CHD cohorts performed significantly worse than atrial and ventricular septum defect cohorts ( = .0003; = .027). An older age at assessment was associated with lower IQ scores in cohorts with transposition of the great arteries ( = .014). Among 13 studies (774 children with CHD) reporting EF compared with controls, the standardized mean difference was -0.56 (95% confidence interval: -0.65 to -0.46) with no predilection for a specific EF domain or age effect. Heterogeneity between studies was large. Intellectual impairments in CHD are frequent, with severity and trajectory depending on the CHD subtype. EF performance is poorer in children with CHD without a specific EF profile. The heterogeneity in studied populations and applied assessments is large. A uniform testing guideline is urgently needed.