Clinical neurologic and developmental studies after cardiac surgery utilizing hypothermic circulatory arrest and cardiopulmonary bypass

Abstract

The dramatic reduction in surgical mortality associated with repair of congenital heart anomalies in recent decades has been accompanied by a growing recognition of adverse neurologic sequels in some of the survivors. Abnormalities of the central nervous system may be a function of coexisting cerebral abnormalities or acquired events unrelated to surgical management (such as paradoxical embolus, cerebral infection, or effects of chronic cyanosis), but insults to the central nervous system appear to occur most frequently during or immediately after surgery. In particular, techniques of support used during neonatal and infant cardiac surgery—cardiopulmonary bypass, profound hypothermia and circulatory arrest—have been implicated as important causes of cerebral injury. This paper will review the effects of bypass and deep hypothermic circulatory arrest on neurodevelopmental outcome.

Effects of propofol on cerebral oxygenation during cardiopulmonary bypass in children

“…While these advances have improved overall surgical outcome, repair of congenital cardiac lesions performed during hypothermic cardiopulmonary bypass with or without total circulatory arrest is still associated with considerable short-and long-term neurological damage. [1][2][3][4][5] The reported incidence of neurological complications of open heart surgery varies widely ranging from 7 to 61% for transient and from 1.6 to 23% for permanent complications. 6,7 Recent reports concerning infants undergoing cardiopulmonary bypass surgery with deep hypothermia and circulatory arrest puts the figure at 25% for permanent neuropsychological injury.…”

Deep hypothermic circulatory arrest in cyanotic piglets is associated with increased neuronal necrosis

“…Yet, there is conflicting evidence on the adverse impact of deep hypothermic circulatory arrest, and its potential for adverse consequences on vulnerable subgroups such as the cyanotic neonate, remains unclear. [2][3][4] Given the inconsistency of findings regarding the impact of deep hypothermic circulatory arrest and the recognised potential for neurologic morbidity, the purpose of this study was to determine if cyanosis and deep hypothermic circulatory arrest, when used together, result in worse neurologic injury compared to either alone.…”

Cerebral Oxygenation during Pediatric Cardiac Surgery: Identification of Vulnerable Periods using Near-infrared Spectroscopy

“…1 These complications appear to occur more commonly after deep hypothermic circulatory arrest. 2 Although the etiology of neurologic injury is almost certainly multifactorial, imbalance between cerebral oxygen supply and demand is likely to play an important role. The ability to monitor cerebral oxygenation during, and immediately after, cardiac surgery offers the possibility for predicting and preventing neurological injury.…”

“…The ability to monitor cerebral oxygenation during, and immediately after, cardiac surgery offers the possibility for predicting and preventing neurological injury. 2 In this study we have used near-infrared spectroscopy to help identify periods of mismatch between cerebral oxygen supply and demand during pediatric cardiac surgery.…”