Cognitive Functioning 20 Years After Arterial Switch

Results of the NEUROSWITCH study following patients with congenital heart disease were presented at the Ninety-sixth Annual Meeting of The American Association for Thoracic 25 Surgery, Baltimore, MD, in May 2016.

Researchers provided the first description of the cognitive and psychosocial outcomes of adults two decades after a neonatal arterial switch operation for transposition of the great arteries (TGA). “This is an essential step toward developing prevention strategies and adapted treatments, such as cognitive remediation or psychological support, for certain patients,” Says David Kalfa, MD, PhD, Assistant Professor of Surgery at Columbia and the primary investigator of this international study. 

Sixty-seven adults with transposition of the great arteries now in their early 20s were compared to 43 healthy subjects of the same age, gender and educational level.  Researchers looked at global cognitive functioning, psychological condition and quality of life using validated tools. Specific neuropsychological impairments are increasingly documented into adolescence but remain rarely investigated in adulthood.

When compared to healthy subjects, adults with operated TGA had significantly lower Full-Scale IQ, Verbal IQ and Performance IQ scores. These findings are in accordance with previous findings showing lower IQ scores in children or adolescents with complex CHD. Predictors of worse outcomes included female gender, parents’ lower educational level, late age at surgery, and long hospitalization stay. "Future assessments,” says Dr. Kalfa, "should examine several cognitive domains such as attention, memory and executive functions". 

Lower IQ scores in these patients were also associated with a poorer quality of life and a lower academic success. Early impediments to academic success may have negative effects on the social and professional adaptive skills of adult patients. In our study, the unemployment rate among adult patients (non-students) was slightly higher than in healthy subjects.  “This increased risk of precariousness deserves particular attention,” says Dr. Kalfa, “as it affects financial security and well-being.”

In adult patients, researchers found few cases of depression but noted a high frequency of anxiety symptoms. This could be explained by the fact that entrance into adulthood is a stressful period marked by changes and new challenges, says Dr. Kalfa.  During this period, adults with complex CHD may face additional difficulties—discomfort related to their scar, treatment decision-making and need for surgical re-intervention, concerns about their life expectancy, a pregnancy involving risks. Overall TGA patients were satisfied with their quality of life, but those with cognitive or psychological difficulty reported a poorer quality of life.

“Despite satisfactory outcomes in most adults operated on for TGA, a substantial proportion of patients have cognitive or psychological difficulties that could reduce their academic success and quality of life,” adds Dr. Kalfa.  “We need to better understand the long-term outcomes for this population so we can begin providing appropriate prevention, surveillance and care.”