Predictors of Neurological Outcome Following Infant Cardiac Surgery Without Deep Hypothermic Circulatory Arrest

Agnieszka Kosiorek, Department of Radiology, Cantonal Hospital Aarau, Aarau, Switzerland.
Mary T. Donofrio, Division of Cardiology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
David Zurakowski, Departments of Surgery and Anesthesiology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.
Justus G. Reitz, Division of Prenatal Diagnosis & Therapy, Department of Obstetrics and Gynecology, Justus-Liebig-University, University Hospital Giessen & Marburg, Giessen, Germany.
Lauren Tague, Pediatric and Fetal Cardiologist, Pediatric Cardiology Associates, LLC, Syracuse, NY, USA.
Jonathan Murnick, Division of Diagnostic Imaging & Radiology, Departments of Radiology & Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Roland Axt-Fliedner, Division of Prenatal Diagnosis & Therapy, Department of Obstetrics and Gynecology, Justus-Liebig-University, University Hospital Giessen & Marburg, Giessen, Germany.
Catherine Limperopoulos, Division of Diagnostic Imaging and Radiology, Developing Brain Institute, Children's National Hospital, Radiology and Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Can Yerebakan, Division of Cardiovascular Surgery, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Jessica L. Carpenter, Division of Pediatric Neurology, University of Maryland Medical Center, University of Maryland, School of Medicine, Baltimore, MD, 21201, USA. jessica.carpenter@som.umaryland.edu.

Document Type

Journal Article

Publication Date

1-1-2022

Journal

Pediatric cardiology

Volume

43

Issue

1

DOI

10.1007/s00246-021-02693-z

Keywords

Congenital heart disease (CHD); Magnetic resonance imaging (MRI); Neurodevelopmental; Outcome; Stroke

Abstract

The aim of this study is to describe the clinical characteristics, perioperative course and neuroimaging abnormalities of infants with congenital heart disease (CHD) undergoing heart surgery without deep hypothermic circulatory arrest (DHCA) and identify variables associated with neurological outcome. Infants with CHD undergoing open-heart surgery without DHCA between 2009 and 2017 were identified from a cardiac surgery database. Full-term infants < 10 weeks of age at the time of surgery who had both a pre- and postoperative brain magnetic resonance imaging exam (MRI) were included. Clinical characteristics and perioperative variables were collected from the electronic medical record. Brain Injury Scores (BIS) were assigned to pre- and postoperative brain MRIs. Variables were examined for association with neurological outcome at 12 months of age or greater. Forty-two infants were enrolled in the study, of whom 69% (n = 29) had a neurological assessment ≥ to 12 months of age. Adverse neurological outcome was associated with longer intensive care unit (ICU) stay (P = 0.003), lengthier mechanical ventilation (P = 0.031), modified Blalock-Taussig (MBT) shunt procedure (P = 0.005) and postoperative seizures (P = 0.005). Total BIS scores did not predict outcome but postoperative infarction and/or intraparenchymal hemorrhage (IPH) was associated with worse outcome by multivariable analysis (P = 0.018). Infants with CHD undergoing open-heart surgery without DHCA are at increased risk of worse neurological outcome when their ICU stay is prolonged, mechanical ventilation is extended, MBT shunt is performed or when postoperative seizures are present. Cerebral infarctions and IPH on postoperative MRI are also associated with worse outcome.

Department

Pediatrics

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