Neurodevelopmental Outcomes After Cardiac Surgery for Acyanotic Congenital Heart Disease in Iranian Children: A Single Center Study

Background: Children with congenital heart disease (CHD) who undergo cardiopulmonary bypass (CPB) are particularly at risk for neurodevelopmental impairment. Objectives: This study aims to assess the neurodevelopmental outcomes of Iranian children with acyanotic congenital heart disease (aCHD) post-CPB, comparing them to a matched healthy control group. Methods: We performed a retrospective cohort study at Rajaie Cardiovascular Medical and Research Center, Tehran, Iran, from 2019 to 2022. Fifty children aged 4 to 69 months with acyanotic and noncomplex CHD who required corrective open-heart surgery and 50 healthy children as a control group were recruited for this study. Initial information about the child, including age, gender, parents' education level, parental consanguinity, economic status, and feeding type, was collected. The Modified Denver Developmental Screening Test II (DDST II) was used to assess developmental milestones in these children before and after surgery. The results of the tests were then compared to matched controls without CHD. Comparative analyses between the case and control groups were performed using chi-square tests and Mann-Whitney U tests. Pre- and post-operation comparisons within the case group were assessed using the Wilcoxon Signed Ranks Test. The normality of the data was tested using the Kolmogorov-Smirnov test. All statistical analyses were conducted using SPSS software version 16. Results: Significant differences were found between groups in maternal (P = 0.047) and paternal education levels (P = 0.015). Pre-operatively, children in the aCHD group had lower fine motor adaptive skills (P < 0.001) and total developmental scores (P = 0.022) than the control group, as measured by the modified Denver II test. Post-surgery, no significant improvements were observed in developmental domains or total scores (P = 0.994), suggesting that corrective surgery did not result in immediate neurodevelopmental benefits. Conclusions: While surgery did not lead to immediate improvements in developmental skills, parental education emerged as a significant contributor to better outcomes. These findings reinforce the need for multidimensional and interdisciplinary care approaches that address both medical and socio-environmental determinants of child development.