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Neurological complications after pediatric cardiac surgery
Ergin Arslanoğlu1, Kenan Abdurrahman Kara1, Fatih Yiğit1
1Pediatric Cardiovascular Surgery Department, Kartal Kosuyolu High Education and Training Hospital, Cevizli, 2, Denizer Caddesi, Cevizli Kavşağı, 34865 Kartal, Istanbul, Turkey.
Insights
Neurological complications after pediatric heart surgery affect 4.2% of patients, leading to seizures, confusion, or hemiparesis. Early detection and prevention are crucial for improving outcomes in this vulnerable population.
Area of Science:
- Pediatric Cardiology
- Neurology
- Critical Care Medicine
Background:
- Pediatric open-heart surgery survival rates are increasing.
- Neurological complications remain a significant cause of mortality and morbidity.
- Technological advances and surgical experience are reducing complications, but neurological issues persist.
Purpose of the Study:
- To evaluate neurological complications in pediatric patients post-heart surgery.
- To analyze the incidence, types, and outcomes of neurological complications.
- To contribute to the understanding and management of these complications.
Main Methods:
- Retrospective review of 162 pediatric patients with neurological symptoms (>24h) after heart surgery.
- Analysis of neurological examinations, cranial CT, and MRI records.
- Inclusion criteria: 0-205 months old, neurological symptoms within 10 days post-surgery.
Main Results:
- An incidence of 4.2% for neurological complications was observed in 162 out of 3849 patients.
- Common complications included seizures (42.6%), stupor (24.1%), hemiparesis (22.8%), and confusion (10.5%).
- Mortality was 33.3% overall; 37.8% in stroke, 40% in intracranial bleeding, and 14.3% in no radiological findings groups.
Conclusions:
- Neurological complications are a serious concern after pediatric cardiac surgery.
- Further research is needed due to insufficient literature on this topic.
- Primary prevention and careful monitoring of neurological events are essential.
Background:
The number of pediatric patients who survive open-heart surgery has increased in recent years and the complications seen in this patient group continue to decrease with each technological advance, including new surgical and neuroprotective techniques and the improvement in surgeons' experience with this patient population. However, neurological complications, which are the most feared and difficult to manage, require long-term follow-up, and increase hospital costs remain a leading cause of mortality and morbidity in this cohort.
Results:
We evaluated the neurological physical examination, cranial computed tomography (CT), and magnetic resonance (MRI) records of 162 pediatric patients with neurological symptoms lasting more than 24 h after undergoing heart surgery in our clinic between June 2012 and May 2020. The patients' ages ranged from 0 to 205 months, with a mean of 60.59 ± 46.44 months.Of the 3849 pediatric cardiac surgery patients we screened, 162 had neurological complications in the early period (the first 10 days after surgery). The incidence was calculated as 4.2%; 69 patients (42.6%) experienced seizures, 17 (10.5%) experienced confusion, 39 (24.1%) had stupor, and 37 (22.8%) had hemiparesis. Of the patients who developed neurological complications, 54 (33.3%) died. Patients with neurological complications were divided into 3 groups: strokes (n = 90), intracranial bleeding (n = 37), and no radiological results (n = 35). Thirty-four patients (37.8%) in the stroke group died, as did 15 (40%) in the bleeding group, and 5 (14.3%) in the no radiological results group.
Conclusions:
Studies on neurological complications after pediatric heart surgery in the literature are currently insufficient. We think that this study will contribute to a more detailed discussion of the issue. Responses to neurological events and treatment in the pediatric group may differ compared to the adult age group. Primary prevention methods should be the main approach in combating neurological complications; their formation mechanisms should be carefully monitored and preventive treatment strategies should be developed.
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