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Perioperative electroencephalographic seizures in infants undergoing repair of complex congenital cardiac defects
S L Helmers1, D Wypij, J E Constantinou
1Department of Neurology, Children's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Deep hypothermic circulatory arrest (DHCA) and low-flow cardiopulmonary bypass (LFB) are cardiac surgery support methods. EEG seizures are common post-surgery, with DHCA, longer arrest times, and VSD diagnosis being associated factors.
Area of Science:
- Pediatric Cardiology
- Neurocritical Care
- Cardiac Surgery
Background:
- Infants with congenital heart defects often require early surgical repair.
- Deep hypothermic circulatory arrest (DHCA) and low-flow cardiopulmonary bypass (LFB) are common surgical support methods.
- Both DHCA and LFB have been linked to adverse neurological outcomes, including seizures.
Purpose of the Study:
- To compare the incidence and characteristics of electroencephalogram (EEG) and clinical seizures in infants undergoing surgical correction for D-transposition of the great arteries.
- To identify factors associated with postoperative seizures in this population.
Main Methods:
- A single-center study randomized 171 infants undergoing D-transposition of the great arteries repair to either DHCA or LFB.
- Continuous EEG-video monitoring was performed for the first 48 hours postoperatively.
- Clinical seizures were monitored for the first postoperative week.
Main Results:
- The incidence of EEG seizures (20%) was significantly higher than clinical seizures (6%).
- Most EEG seizures occurred between 13 and 36 hours postoperatively, with durations varying widely.
- Factors associated with EEG seizures included DHCA, longer duration of circulatory arrest, and ventricular septal defect (VSD) diagnosis.
Conclusions:
- EEG seizures are common in infants following cardiac surgery for D-transposition of the great arteries.
- Continuous EEG monitoring is crucial for detecting subclinical seizures.
- Understanding seizure mechanisms in this vulnerable population is important for improving neurological outcomes.
Abstract:
Many infants with cardiac anomalies undergo repair early in life. Both commonly used support techniques, deep hypothermic circulatory arrest (DHCA) and low-flow cardiopulmonary bypass (LFB), may be associated with adverse neurological outcomes, including seizures. In a single center study, 171 infants undergoing correction for D-transposition of the great arteries were randomized to one of these support techniques. Incidence and onset times of EEG seizures during continuous EEG-video monitoring in the first 48 h postoperatively and clinical seizures in the first postoperative week were compared. EEG seizures were characterized by time, duration, and localization of onset. Incidence of EEG seizures (20%) was more than 3 times that of clinical seizures (6%). Most infants with EEG seizures had multiple seizures beginning between 13 and 36 h postoperatively. Durations ranged from 6 s to 980 min. Onset of EEG seizures occurred most commonly in frontal and central regions. Factors associated with EEG seizures included randomization to DHCA, longer duration of circulatory arrest, and diagnosis of VSD. In this study EEG seizures were common following this type of cardiac surgery, illustrating the importance of EEG monitoring in detecting seizures. This data adds insight into mechanisms of seizures in infants undergoing cardiac surgery.