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Postoperative neurologic complications after open heart surgery on young infants
G Miller1, K D Eggli, C Contant
1Section of Pediatric Neurology, Baylor College of Medicine, Houston, Tex., USA.
Insights
Postoperative neurologic complications in infants undergoing heart surgery are linked to hypothermia duration and lesion severity. These factors, along with preexisting conditions, influence outcomes like alertness and seizures.
Area of Science:
- Pediatric Cardiology
- Pediatric Neurology
- Cardiovascular Surgery
Background:
- Congenital heart disease (CHD) necessitates surgical intervention in infants.
- Hypothermic cardiopulmonary bypass (hCPB) is a common surgical technique for CHD.
- Neurologic complications are a significant concern following hCPB in neonates.
Purpose of the Study:
- To investigate the relationship between preoperative, intraoperative, and postoperative variables and neurologic complications in infants undergoing hCPB for CHD.
- To identify risk factors associated with mortality and neurologic morbidity.
Main Methods:
- Prospective analysis of 91 infants undergoing 100 hCPB procedures for CHD.
- Assessment of neurologic status (alertness, tone, seizures, etc.) before surgery and at hospital discharge.
- Correlation of neurologic outcomes with patient characteristics, metabolic status, surgical variables, and preoperative findings.
Main Results:
- 18% overall mortality; 40% mortality for severe left-sided lesions.
- 19% experienced reduced alertness, 15% had seizures, and 7% had persistent hypotonia at discharge.
- Longer deep hypothermia (>60 minutes) correlated with decreased alertness, chorea, and hypotonia.
- Preexisting brain abnormalities and severe left-sided lesions were associated with adverse outcomes.
Conclusions:
- Mortality and neurologic morbidity in infants after hCPB for CHD are multifactorial.
- Key contributing factors include the type of cardiac lesion, pre-existing brain abnormalities, duration of deep hypothermia, and perioperative strokes.
- Risk stratification and targeted interventions are crucial for improving neurodevelopmental outcomes.
Objective:
To ascertain the relation between postoperative neurologic complications and variables occurring before, during, and after hypothermic cardiopulmonary bypass surgery to correct congenital heart disease in young infants.
Design:
Prospective analysis of mortality and neurologic morbidity before hospital discharge; systematic comparison with patient characteristics, metabolic status, surgery variables; and preoperative neurologic findings of the patients.
Setting:
Intensive care unit in tertiary care center.
Patients:
Consecutive sample of 91 full-term infants who underwent 100 operations between January 1989 through December 1992. Nine infants had more than one operation during the study period.
Main Outcome Measures:
Levels of alertness, tone, focal signs, dyskinesia, pyramidal signs, seizures, and death.
Results:
Reduced level of alertness at discharge from the hospital in 19% of patients; seizures in 15% (70% focal); severe hypotonia in 11% before surgery, and in 7% at discharge from hospital; generalized pyramidal findings in six (7%); asymmetry of tone in 5%; and chorea that did not persist in 11%. Results of cranial ultrasound tests were abnormal in 20% of patients. Of these those with abnormal cranial ultrasound examinations 55% were abnormal before surgery. Overall mortality was 18%. Of the patients who died, 59% had interrupted aortic arch or hypoplastic left heart syndrome. Mortality for patients with these lesions was 40%. Alertness (P = .005), chorea (P = .03), and hypotonia (P = .02) were associated with duration of deep hypothermia longer than 60 minutes. No association was found among other outcomes and study variables, except the relation between severe left-sided heart lesions and mortality.
Conclusions:
Mortality and neurologic morbidity after open heart surgery on young infants may be due to several factors, including type of lesion, preexisting brain abnormalities, duration of deep hypothermia, and strokes.