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Infant Heart Surgery: Central Nervous System Sequelae of Circulatory Arrest (BCAS)

This study has been completed.
National Heart, Lung, and Blood Institute (NHLBI)
Information provided by (Responsible Party):
Jane W. Newburger, Children's Hospital Boston Identifier:
First received: October 27, 1999
Last updated: July 28, 2016
Last verified: July 2016
To compare the influence of two surgical anesthetic techniques, hypothermia with circulatory arrest or hypothermia with low-flow bypass perfusion, on neurologic functioning in infants undergoing heart surgery.

Condition Intervention Phase
Cardiovascular Diseases
Cerebral Anoxia
Cerebrovascular Disorders
Defect, Congenital Heart
Heart Diseases
Transposition of Great Vessels
Heart Septal Defects, Ventricular
Procedure: cardiac surgical procedures
Procedure: cardiopulmonary bypass
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Primary Purpose: Treatment
Official Title: Infant Heart Surgery: Central Nervous System Sequelae of Circulatory Arrest

Resource links provided by NLM:

Further study details as provided by Boston Children’s Hospital:

Enrollment: 171
Study Start Date: December 1988
Study Completion Date: October 1993
Primary Completion Date: February 1992 (Final data collection date for primary outcome measure)
Detailed Description:


The pediatric medical community has long been concerned about the increased incidence of cerebral dysfunction among newborns with severe cyanotic congenital heart disease. There has been concern about a great number of potential predisposing factors including the effects of hypoxemia and acidosis, trauma during cardiac catheterization, and the duration of prolonged decreased arterial oxygen saturation. Many infants undoubtedly undergo significant brain damage prior to surgery, but may be subject to further insult in the peri-operative period. The proposed trial studied circulatory arrest versus low-flow bypass methods of surgical support in a homogeneous group of patients who were managed in identical fashion in all other aspects of their treatment. Major factors, such as the influence of cardiac catheterization and presurgical status were specifically incorporated into the primary statistical analysis. This was important in order to identify significant predisposing causes of brain injury beyond the surgical techniques being compared, and to increase the power of the comparison.


Randomized, partially blinded. Infants were assigned to deep hypothermia and either circulatory arrest or low-flow bypass support during arterial switch surgical repair of transposition of the great arteries. Randomization was stratified by diagnosis (with or without septal defect) and by specific surgeon of three, thus yielding six strata within each treatment group. Randomization was also blocked to minimize imbalances in treatment assignment between strata. The study was partially blinded, in that outcome data were obtained by investigators who were unaware of management, surgical care, and intensive care were standardized. Hemodynamic assessment was made early in the post-operative period. The outcomes of primary interest (magnetic resonance imaging, neurologic examination, and psychometric testing) were reviewed at the one-year evaluation, to maximize relevance to the long-term prognosis. Pre-operative and seven-to-ten day post-operative neurologic examination was also carried out. Developmental status at one year was measured by the Bayley developmental scales and the Fagan test of infant intelligence. Brain function was assessed by neurologic examination at one year. The recruitment period extended from April 1988 to February 1992.

The trial was extended through December 1997 to allow four years of follow-up. The follow-up allowed the assessment of a primary outcome variable in the neurologic domain and a primary outcome variable in the developmental domain. The primary outcome variable of the neurologic examination resulted in an ordered classification of three categories of normal, minor, and major dysfunction, such as apraxia or cerebral palsy. Development was assessed using standardized measures of cognition, behavior, language, attention, and motor skills. The primary outome variable for the developmental evaluation was the intelligence quotient on the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-R). Secondary outcome variables included measurements of behavior and performance in specific domains of speech and language, visual motor integration, attention, motor function, and temperament.

Beginning in January 1998, the study was extended for an additional four years through December 2001 to compare the effects of the two intraoperative methods with respect to developmental and neurologic status at eight years of age. Developmental status was assessed by the Wechsler Individual Achievement Test (primary outcome) and by the presence of learning disabilities and performance in specific neuropsychologic domains (secondary outcomes). Neurologic status was determined by neurologic exam (primary outcome) and by specific types of dysfunction such as motor problems. The study also compared the academic and intellectual performance of the cohort at age eight years to population norms and used the data to identify correlates of the children's eight year outcomes, as well as their development between ages one and eight.


Ages Eligible for Study:   up to 1 Year   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Boy and girl infants, up to three months of age, with transposition of the great arteries with or without septal defect.
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Please refer to this study by its identifier: NCT00000470

Sponsors and Collaborators
Boston Children’s Hospital
National Heart, Lung, and Blood Institute (NHLBI)
OverallOfficial: Jane Newburger Children's Hospital Medical Center, Cincinnati
  More Information


Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Jane W. Newburger, Associate Cardiologist-in-Chief, Boston Children's Hospital, Children's Hospital Boston Identifier: NCT00000470     History of Changes
Other Study ID Numbers: 59
R01HL041786 ( US NIH Grant/Contract Award Number )
Study First Received: October 27, 1999
Last Updated: July 28, 2016
Individual Participant Data  
Plan to Share IPD: No
Plan Description: Not required when trial was performed in 1988-92

Additional relevant MeSH terms:
Transposition of Great Vessels
Cardiovascular Diseases
Heart Diseases
Heart Septal Defects
Cerebrovascular Disorders
Congenital Abnormalities
Heart Defects, Congenital
Hypoxia, Brain
Heart Septal Defects, Ventricular
Cardiovascular Abnormalities
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases processed this record on April 28, 2017