A Contemporary Meta-analysis on Sex Differences in Surgical Mortality and Neurodevelopment in Congenital Heart Defects.

Abstract Need and purpose of review Given the increasing survival rates among congenital heart disease (CHD) patients and increasing awareness in sex-related disparities in CHD, there is a need to assess the impact of surgical interventions on neurodevelopmental outcomes and to explore potential differences in surgical mortality and neurodevelopmental outcomes between male and female patients. Methods In this systematic review, we adhered to PRISMA guidelines and PROSPERO registration. We searched articles published from 2015 to 2021 using MeSH descriptors in three major databases. Study selection criteria focused on pediatric CHD patients undergoing primary cardiac surgery. We reviewed 163 articles that met inclusion criteria. The definition and assessment of neurodevelopmental impairment, data extraction, risk of bias assessment, and statistical analysis methods were adhered by blinded reviewers. Main conclusions Previous studies have reported higher rates of early childhood mortality in female patients and higher rates of neurodevelopmental impairment in male patients with CHD requiring surgery. Our meta-analysis suggests that these differences may no longer be valid in contemporary surgical cohorts. It is unclear if sex-related risk factors have truly been mitigated with current surgical and medical approaches. Our meta-analysis does underscore the need for further research considering sex and investigating neurodevelopmental outcomes.