REVIEW ARTICLE New Approaches to Neuroprotection in Infant Heart Surgery

Advances in surgical techniques and perioperative management have led to dramatic improvements in outcomes for children with complex congenital heart disease (CHD). As the num- ber of survivors continues grows, clinicians are becoming increas- ingly aware that adverse neurodevelopmental outcomes after surgical repair of CHD represent a significant cause of morbidity, with widespread neuropsychologic deficits in as many as 50% of these children by the time they reach school age. Modifications of intra- operative management have yet to measurably impact long-term neurologic outcomes. However, exciting advances in our understand- ing of the underlying mechanisms of cellular injury and of the events that mediate endogenous cellular protection have provided a variety of new potential targets for the assessment, prevention, and treatment of neurologic injury in patients with CHD. In this review, we will discuss the unique challenges to developing neuroprotective strate- gies in children with CHD and consider how multisystem approaches to neuroprotection, such as ischemic preconditioning, will be the focus of ongoing efforts to develop new diagnostic tools and thera- pies. Although significant challenges remain, tremendous opportu- nity exists for the development of diagnostic and therapeutic inter- ventions, which can serve to limit neurologic injury and ultimately improve outcomes for infants and children with CHD. (Pediatr Res 68: 1-2, 2010)