Perioperative Cerebral Near-Infrared Spectroscopy Variability and Neurodevelopmental Outcomes in Congenital Heart Patients
Second, d-transposition of great arteries (d-TGA) represents the majority of the two-ventricle patient population in this study. An important factor for NIRS would be the systemic arterial saturations. Usually, balloon atrial septostomy improves mixing at the atrial level significantly increasing their saturations. In this cohort, did d-TGA patients undergo balloon atrial septostomy? Furthermore, septostomy in this age group has been associated with white matter MRI changes (4), which could have adverse neurologic outcomes (5). Thus, it would be important to consider this factor while discussing the pre- and postsurgical morbidities and outcomes in this patient population, as they are quite different from other groups of two ventricular repairs as their fetal and postnatal physiology are very different.
Third, the authors have placed all the patients with neuroimaging into one group for the neurodevelopmental outcome, without separating them into different congenital heart disease groups, which I think is not fair, as there are significant differences in the physiology among different groups of congenital heart diseases. The number of neuro MRIs and cranial ultrasounds is small, but even observing a trend in different groups would be relevant given the limitations of the data.