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Risk Factors of Perioperative Brain Injury in Children Under Two Years Undergoing Coarctation Repair
Min Cheng1, Hong-Zhen Xu2, Kai-Jun Zhang3
1Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Longer operation times and lower pulse pressure increase perioperative brain injury risk in pediatric coarctation of the aorta repair. Maintaining stable hemodynamics during cardiopulmonary bypass is crucial for preventing brain injury.
Area of Science:
- Pediatric Cardiology
- Neurosurgery
- Cardiovascular Surgery
Background:
- Coarctation of the aorta (CoA) repair in young children often involves complex procedures.
- Perioperative brain injury (PBI) is a potential complication in these surgeries.
- Understanding factors contributing to PBI is essential for improving patient outcomes.
Purpose of the Study:
- To investigate clinical manifestations of PBI after surgical repair of CoA with other heart malformations.
- To identify factors associated with PBI development in children under two years old.
- To evaluate the link between hemodynamic instability and PBI.
Main Methods:
- Retrospective review of clinical data from 100 children undergoing CoA repair (2010-2021).
- Univariate and multivariate analyses to identify PBI risk factors.
- Hierarchical and K-means cluster analyses to assess hemodynamic instability's association with PBI.
Main Results:
- Multivariate analysis identified longer operation duration (OR 2.93) and lower minimum pulse pressure (PP) (OR 0.22) as independent risk factors for PBI.
- Cluster analysis revealed PBI predominantly in subgroups with specific hemodynamic profiles (PP minimum, MAP dispersion, SVR average).
- Eight children experienced postoperative complications, all with favorable neurological outcomes at one year.
Conclusions:
- Lower minimum pulse pressure and longer operation duration are independent risk factors for PBI in pediatric CoA repair.
- Avoiding hemodynamic instability during cardiopulmonary bypass is critical.
- Favorable neurological outcomes were observed one year post-surgery despite initial complications.
