For a study, researchers sought to investigate predictors of decreased executive function in teenagers following major congenital heart disease (CHD) surgical repair.

They reviewed data from three single-center studies of adolescents with d-transposition of the great arteries (d-TGA), tetralogy of Fallot (TOF), and Fontan repair to look at patient characteristics, medical and surgical history, and family social class. Machine learning models were created using recursive partitioning to predict an executive function composite score based on five subtests of the Delis-Kaplan Executive Function System (population mean 10, SD 3).

About 386 patients (139 d-TGA, 91 TOF, 156 Fontan) with an executive function composite score of 8.6±2.4 and of age 15.1±2.1 (mean ± SD) were included in the study. The most relevant predictor emerged as family social class. Patients with low to medium socioeconomic status (Hollingshead index<56) who had one or more neurologic episodes and a TOF diagnosis had the lowest (worst) mean executive function score (5.3). Conversely, subjects with a high socioeconomic class (Hollingshead index≥56) and a shorter time of profound hypothermic circulatory arrest had the highest (best) mean score (9.7). Low birth weight and a higher number of catheterizations were also associated with lower executive function scores.

Even in the presence of medical risk factors, family socioeconomic status was the best predictor of executive function in adolescents with significant CHD in regression tree modeling. CHD diagnosis, birth weight, neurologic events, and the number of surgeries were also predictive. The findings emphasized the significance of socioeconomic status in reducing the likelihood of executive dysfunction in CHD.