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[Acute neurological complications after pediatric cardiac surgery: still a long way to go]
A Avila-Alvarez1, I Gonzalez-Rivera, A Ferrer-Barba
1Unidad de Neonatología, Servicio de Pediatría, Complejo Hospitalario Universitario de A Coruña, España. alexavila81@hotmail.com
Insights
Neurological complications occur in 4.2% of patients after cardiac surgery, with seizures being most common. Central nervous system issues increase morbidity and hospitalization, necessitating neurological monitoring.
Area of Science:
- Neurology
- Cardiology
- Critical Care Medicine
Context:
- Congenital heart disease and cardiac surgery are associated with increasing neurological concerns.
- Postoperative neurological complications impact patient outcomes and healthcare resource utilization.
Purpose:
- To investigate the incidence, types, and outcomes of neurological complications following cardiac surgery.
- To identify risk factors and associated morbidities of neurological complications in this patient population.
Summary:
- A retrospective review of 900 patients found a 4.2% incidence of neurological complications (21 peripheral, 17 central).
- Central nervous system complications, including seizures and cerebrovascular accidents, were linked to longer bypass/aortic cross times, increased ICU stay, and mechanical ventilation duration.
- Clinical seizures were the most frequent complication, with significant mortality and morbidity observed.
Impact:
- Findings underscore the importance of neurological monitoring in patients with congenital heart disease undergoing cardiac surgery.
- Early detection and management of neurological complications can potentially reduce morbidity and hospitalization time.
- This study contributes to understanding the neurological sequelae of cardiac surgery, guiding clinical practice and future research.
Introduction:
There has been an increasing concern over the neurological complications associated with congenital heart disease and cardiac surgery.
Material And Methods:
We performed a retrospective, case-control, observational review of the postoperative period in the intensive care unit of patients undergoing cardiac surgery over the past 10 years. We selected 2 control patients for each case, matched for surgical complexity.
Results:
A total of 900 patients were reviewed. We found 38 neurological complications (4.2%), of which 21 (55.3%) were in the peripheral nervous system and 17 (44.7%) in the central nervous system. The complications involving the central nervous system (1.9% of total) consisted of 8 seizures, 4 cerebrovascular accidents, 4 hypoxic-ischemic encephalopathy events, and 1 reversible neurological deficit. At the time of discharge, 35.3% were symptomatic and 17.6% had died. Patients with neurological complications had a longer bypass time (P=.009), longer aortic cross time (P=.012), longer hospitalization in intensive care (P=.001), longer duration of mechanical ventilation (P=.004) and an increased number of days under inotropic support (P=.001).
Conclusions:
Our incidence of neurological complications after cardiac surgery is similar to that previously described. Clinical seizures are the most common complication. Central nervous system complications are associated with a higher morbidity and hospitalization time. Units caring for patients with congenital heart disease must implement neurological monitoring during and after cardiac surgery to prevent and to detect these complications earlier.
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