Background New intraparenchymal brain injury on MRI is observed in 36–73% of neonates after cardiac surgery with cardiopulmonary bypass (CPB). Brain immaturity in this population is common. We performed brain magnetic resonance imaging (MRI) before and after neonatal cardiac surgery, using a high flow CPB protocol, hypothesizing that MRI brain injury would be associated with brain immaturity. Methods CPB protocol included 150 ml/kg/min flows, pH stat management, hematocrit >30%, and high flow antegrade cerebral perfusion. Regional brain oxygen saturation (rSO2) was monitored, with a treatment protocol for rSO2 <50%. Brain MRI, consisting of T1, T2, and diffusion weighted imaging, and MR spectroscopy were performed preoperatively, 7 days postoperatively, and at age 3–6 months. Results Twenty-four of 67 patients (36%) had new postoperative white matter injury (WMI), infarction, or hemorrhage, and 16% had new WMI. Associations with preoperative brain injury included low brain maturity score (p=0.002). Postoperative WMI was associated with single ventricle (SV) diagnosis (p=0.02), preoperative WMI (p<0.001) and low brain maturity score (p=0.05). Low brain maturity score was also associated with more severe postoperative brain injury (p=0.01). Forty-five patients had a 3rd scan, with a 27% incidence of new minor lesions, but 58% of previous lesions had partially or completely resolved. Conclusions We observed a significant incidence of both pre- and postoperative MRI abnormality, and an association with brain immaturity. Many lesions resolved in the first 6 months after surgery. Timing of delivery and surgery with bypass could affect the risk of brain injury.

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Bovine jugular grafts are associated with a significantly greater risk of late endocarditis but with lower reintervention rates compared with other valved conduits. The risk of endocarditis and durability must be balanced during conduit selection. Antibiotic prophylaxis and a high index of suspicion for endocarditis are warranted in patients with bovine jugular grafts.