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Cerebral Protection in Pediatric Cardiac Surgery
Sheida Shams-Molkara1, Vitor Mendes2, François Verdy3
1Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
Insights
Pediatric cardiac surgery advances improve survival but leave children vulnerable to brain lesions from surgery or other factors. Current protective measures offer limited benefit, necessitating new strategies to prevent these cerebral injuries.
Area of Science:
- Cardiology
- Pediatric Surgery
- Neuroscience
Background:
- Pediatric cardiac surgery has significantly improved outcomes for congenital heart disease.
- Patients undergoing surgery remain at high risk for cerebral lesions.
- Infants and children have higher cerebral metabolism, increasing susceptibility to brain injury.
Purpose of the Study:
- To review protective measures against cerebral lesions in pediatric cardiac surgery.
- To explore reasons for the limited success of current interventions.
- To propose future strategies for mitigating brain injury risk.
Main Methods:
- Review of existing literature on pediatric cardiac surgery and cerebral lesions.
- Analysis of perioperative and non-perioperative risk factors.
- Discussion of the pathophysiology of brain injury in this population.
Main Results:
- Despite numerous preventive measures, cerebral lesions remain a significant concern.
- Factors contributing to lesions include cardiopulmonary bypass, anesthesia, chromosomal anomalies, and hospital care duration.
- Existing interventions have shown only modest impact on reducing lesion incidence.
Conclusions:
- Cerebral lesions pose a persistent challenge in pediatric cardiac surgery.
- Further research and novel approaches are needed to enhance brain protection.
- Addressing both perioperative and non-perioperative factors is crucial for improving patient outcomes.
Abstract:
Cardiac surgery, both adult and pediatric, has developed very rapidly and impressively over the past 7 decades. Pediatric cardiac surgery, in particular, has revolutionized the management of babies born with congenital heart disease such that now most patients reach adult life and lead comfortable lives. However, these patients are at risk of cerebral lesions, which may be due to perioperative factors, such as side effects of cardiopulmonary bypass and/or anesthesia, and non-perioperative factors such as chromosomal anomalies (common in children with congenital heart disease), the timing of surgery, number of days on the intensive care unit, length of hospitalization and other hospitalizations in the first year of life. The risk of cerebral lesions is particularly relevant to pediatric cardiac surgery given that cerebral metabolism is about 30% higher in neonates, infants and young children compared to adults, which renders their brain more susceptible to ischemic/hypoxic injury. This issue has been a major concern throughout the history of cardiac surgery such that many preventive measures have been implemented over the years. These measures, however, have had only a modest impact and cerebral lesions continue to be a major concern. This is the subject of this review article, which aims to outline these protective measures, offer possible explanations of why these have not resolved the issue, and suggest possible actions that ought to be taken now.
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