Characterization of children with stroke after cardiovascular surgery: A cross-sectional study

Stroke is an understudied outcome of cardiovascular surgery in the pediatric population. We aimed to investigate the characteristics of patients with stroke after the surgery.

A cross-sectional study was conducted at the Pronto Socorro Cardiológico de Pernambuco, including data from the medical records of children who suffered a stroke among the 321 who underwent cardiovascular surgery between 2017 and 2022. The project was approved by the local ethics committee (approval number: 5,395,437).

There were 11 (3.4 %) strokes (ischemic = 82 %) after a median time of five days (0-89 days). Females predominated (82 %) and the median age was seven months (1-50 months). They had more severe cardiopathies and underwent more simple procedures. The median length of hospital stay after stroke was 37 days (14-119 days). Four patients (36 % vs. 17 %) died with a median survival time of 12.5 days (2-22 days) after the ictus. Patients who died had higher prothrombin times and lower maximum mean arterial pressures. They also tended to have higher INR and higher activated partial thromboplastin time, lower ejection fractions, lower maximum CO2 pressures, and received more red blood cell transfusions.

The incidence of stroke was higher than previously described, with high mortality and prolonged hospital stay. Preoperative management of anemia and coagulopathy should be the subject of studies regarding the risk of ischemic and hemorrhagic stroke, respectively. In addition to coagulopathy, CO₂ pressure, and mean blood pressure may be controllable intraprocedural factors and that may be related to mortality.