Skip to main content Accessibility help

Prediction of preschool functional abilities after early complex cardiac surgery

  • Gwen Y. Alton (a1), Soreh Taghados (a2), Ari R. Joffe (a3), Charlene M. T. Robertson (a1) (a3) (a4), Irina Dinu (a2) and the Western Canadian Pediatric Therapies Follow-Up Group...


Background: It is important to identify early predictors of functional limitations in children after congenital heart surgery to optimise their independence as they prepare for school. The purpose of this study is to determine potentially modifiable predictor variables of functional abilities in pre-school children who underwent complex cardiac surgery at 6 weeks of age or earlier. Methods: This prospective inception cohort study comprised a sample of 165 survivors (63% boys) who had complex cardiac surgery (75% biventricular repairs) at Stollery Children’s Hospital, Edmonton, Alberta. We excluded children with chromosomal abnormalities. When children were 4–5 years of age, the parents completed the Adaptive Behavioral Assessment System II. Regression analysis was used to assess the association between multiple risk factors and each of the four continuous composite scores. Results: The mean scores for the practical domain and general adaptive composite score of the Adaptive Behavioural Assessment System were lower than the conceptual and social domains, with 13.3% of the children having a delay in the practical domain. There was a significant association between the general adaptive (p=0.003; 0.012), conceptual (p=0.0004; 0.042), social (p=0.0007; 0.028), and the practical (p=0.046; 0.003) domain composite scores with the mother’s education and preoperative plasma lactate, respectively. Conclusion: Maternal education may be a marker for the social context of children, and warrants societal attention to improve functional outcomes. Preoperative lactate as a potentially modifiable variable may warrant increased attention to early diagnosis and aggressive resuscitation of young infants with congenital heart disease.


Corresponding author

Correspondence to: G. Y. Alton, RN, MN, Rm 242C, Glen East, Glenrose Rehabilitation Hospital, 10230-111 Avenue, Edmonton, Alberta, Canada T5G 0B7. Tel: 780 735-7999, ext: 15630; Fax: 780 735-7907; E-mail:


Hide All

The first author position is equally shared with Soreh Taghados.


The Western Canadian Pediatric Therapies Follow-Up Group consists of: Patricia Blakely, Saskatoon, SK; Reg Sauvé, Calgary; Diane Moddemann, Winnipeg; Jaya Bodani, Regina, SK; Anne Synnes, Vancouver, BC.



Hide All
1. Rudolph, AM. Congenital Diseases of the Heart: Clinical-Physiological Considerations, 2nd edn. Futura Publishing, Armonk, NY, 2001.
2. Shillingford, AJ, Wernovsky, G. Academic performance and behavioral difficulties after neonatal and infant heart surgery. Pediatr Clin N Am 2004; 51: 16251639.
3. Robertson, CMT, Sauvé, RS, Joffe, AR, et al. The Registry and Follow-up of Complex Pediatric Therapies Program of Western Canada: a mechanism for service, audit, and research after life-saving therapies for young children. Cardiol Res Pract 2011: 965740.
4. Alton, GY, Rempel, GR, Robertson, CMT, Newburn-Cook, CV, Norris, CM. Functional outcomes after neonatal open cardiac surgery: comparison of survivors of the Norwood staged procedure and the arterial switch operation. Cardiol Young 2010; 20: 668675.
5. Majnemar, A, Limperopoulos, C, Shevell, M, Rohlicek, C, Rosenblatt, B, Tchervenkov, C. Developmental and functional outcomes at school entry in children with congenital heart defects. J Pediatr 2008; 153: 5560.
6. Larsen, SH, McCrindle, BW, Jacobsen, EB, Johnsen, SP, Emmertsen, K, Hjortdal, VE. Functional health status in children following surgery for congenital heart disease: a population-based cohort study. Cardiol Young 2010; 20: 631640.
7. Creighton, DE, Robertson, CMT, Sauvé, RS, et al. Neurocognitive, functional, and health outcomes at 5 years of age for children after complex cardiac surgery at 6 weeks of age or younger. Paediatrics 2007; 120: 478486.
8. Menahem, S, Poulakis, Z, Prior, M. Children subjected to cardiac surgery for congenital heart disease. Part 1 – emotional and psychological outcomes. Interact Cardiovasc Thorac Surg 2008; 7: 600604.
9. Amianto, F, Bergui, GC, Abbate-Daga, G, Bellicanta, A, Munno, D, Fassino, S. Growing up with a congenital heart disease: neuro-cognitive, psychopathological and quality of life outcomes. Panminerva Med 2011; 53: 109127.
10. Hövels-Gürich, HH, Seghaye, MC, Däbritz, S, Messmer, BJ, von Bernuth, G. Cognitive and motor development in preschool and school-aged children after neonatal arterial switch operation. J ThoracCardiovas Surg 1997; 114: 578585.
11. Gaynor, JW, Gerdes, M, Nord, AS, et al. Is cardiac diagnosis a predictor of neurodevelopmental outcome after cardiac surgery in infancy? J Thorac Cardiovasc Surg 2010; 140: 12301237.
12. Majnemer, A, Limperopoulos, C, Shevell, M, Rohlicek, C, Rosenblatt, B, Tchervenkov, C. Gender differences in the developmental outcomes of children with congenital cardiac defects. Cardiol Young 2012; 22: 514519.
13. Majnemar, A, Limperopoulos, C, Shevell, MI, Rohlicek, C, Rosenblatt, B, Tchervenkov, C. A new look at outcomes of infants with congenital heart disease. Pediatr Neurol 2007; 40: 197204.
14. McGrew, K, Bruininks, R. The factor structure of adaptive behavior. School Psychol Rev 1989; 18: 6481.
15. Harrison, PL, Oakland, T. Manual of the Adaptive Behaviour Assessment System II. Psychological Corp, Harcourt Assessment Company, San Antonio, Texas, 2003.
16. American Association on Mental Retardation. Mental Retardation: Definition, Classification, and Systems of Support. American Association on Mental Retardation, Washington, DC, 2002.
17. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Text Revision, DSM-IV-TR, 4th edn. American Psychiatric Association, Washington, DC, 2000.
18. Robertson, CMT, Joffe, AR, Sauvé, RS, et al. Outcomes from an interprovincial program of newborn open heart surgery. J Pediatr 2004; 144: 8692.
19. Blishen, RR. The 1981 socioeconomic index for occupations in Canada. Can Res Soc Anth 1987; 24: 465488.
20. Freed, DH, Robertson, CMT, Sauvé, RS, et al. Intermediate-term outcomes of the arterial switch operation for transposition of the great arteries in neonates: alive but well? J Thorac Cardiovasc Surg 2006; 132: 845852.
21. Cheung, PY, Chui, N, Joffe, RA, Rebeyka, IM, Robertson, CMT. The Western Canadian Complex Pediatric Therapies Follow-up Group. Post-operative lactate concentrations predict the outcome of infants aged 6 weeks or less after intracardiac surgery: a cohort follow-up to 18 months. J Thorac Cardiovasc Surg 2005; 130: 837843.
22. Alton, GY, Robertson, CMT, Sauvé, RS, et al. Early childhood health, growth, and neurodevelopmental outcomes after complete repair of total anomalous pulmonary venous correction at 6 weeks or younger. J Thorac Cardiovasc Surg 2007; 133: 905911.
23. Atallah, J, Dinu, IA, Joffe, AR, et al. Two-year survival and mental psychomotor outcomes after the Norwood Procedure: an analysis of the modified Blalock–Taussig shunt and right ventricle-to-pulmonary artery shunt surgical eras. Circulation 2008; 118: 14101418.
24. Forbess, JM, Visconti, KJ, Hancock-Friesen, C, Howe, RC, Bellinger, DC, Jonas, RA. Neurodevelopmental outcome after congenital heart surgery: results from an institutional registry. Circulation 2002; 106 (Suppl 1): I95I102.
25. Wernovsky, G, Stiles, KM, Gauvreau, K, et al. Cognitive development after the Fontan operation. Am Heart Assoc 2000; 102: 883889.
26. McCusker, CG, Doherty, NN, Molloy, B, et al. A randomized controlled trial of interventions to promote adjustment in children with congenital heart disease entering school and their families. J Pediatr Psychol 2012; 37: 10891103.
27. Lipstein, EA. Helping “vulnerable” children – and their parents- lead normal lives. Contemporary Pediatr 2006; 23: 2637.
28. Sparrow, S, Balla, DA, Cicchhetti, DV. Vineland Adaptive Behavior Scales, Interview Edition. Survey Form Manual; A Revision of the Vineland Social Maturity Scale of EA Doll. American Guidance Service, Circle Pines, MN, 1984.


Prediction of preschool functional abilities after early complex cardiac surgery

  • Gwen Y. Alton (a1), Soreh Taghados (a2), Ari R. Joffe (a3), Charlene M. T. Robertson (a1) (a3) (a4), Irina Dinu (a2) and the Western Canadian Pediatric Therapies Follow-Up Group...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed