Effects of Cardiac Surgery and Surgical Procedures on Neurocognitive Function in Patients with Congenital Heart Disease: A Systematic Review and Meta-analysis

Abstract Objective: To determine the neurodevelopmental function in patients with congenital heart disease (CHD) after cardiac surgery and the influence of surgical repair versus transcatheter repair on neurodevelopment.Methods: We searched PUBMED, EMBASE and Cochrane Controlled Trials (Central) in September 2019 by using Medical Subject Headings. We extracted data using a customized data extraction sheet and employed standard methodological procedures as expected by Cochrane. We used a fixed-effect or random-effect model for meta-analysis. Results: We included a total of seven articles. The assessed neurodevelopment outcomes were the full intelligence quotient (full IQ), verbal intelligence quotient (verbal IQ) and performance intelligence quotient (performance IQ). The intelligence quotient was statistically significant after cardiac surgery compared with that of the normal control (full IQ: mean difference = -5.79 [95% CIs -10.14, -1.44], P = 0.009, I2=71%; verbal IQ: mean difference = -4.46 [95% CIs -7.99, -0.93], P = 0.01, I2=56%; performance IQ: mean difference = -7.13 [95% CIs -10.90, -3.35], P =0.0002, I2=64%). The neurodevelopment functions were no different after surgical repair versus transcatheter repair (full IQ: mean difference = 0.19 [95% CIs -4.10, 4.49], P = 0.93, I2=0%; verbal IQ: mean difference = 2.29 [95% CIs -1.60, 6.18], P = 0.25, I2=0%; performance IQ: mean difference = -2.49 [95% CIs -6.49, 1.52], P = 0.22, I2=0%).Conclusion: We found that patients with CHD undergoing cardiac surgery may exhibit a negative effect on neurodevelopment, and there may be no difference in the effects of the two different surgical methods on neurodevelopment.