Neurological complications after pediatric cardiac surgery

Abstract

Background The number of pediatric patients who survive open-heart surgery has increased in recent years and the complications seen in this patient group continue to decrease with each technological advance, including new surgical and neuroprotective techniques and the improvement in surgeons’ experience with this patient population. However, neurological complications, which are the most feared and difficult to manage, require long-term follow-up, and increase hospital costs remain a leading cause of mortality and morbidity in this cohort. Results We evaluated the neurological physical examination, cranial computed tomography (CT), and magnetic resonance (MRI) records of 162 pediatric patients with neurological symptoms lasting more than 24 h after undergoing heart surgery in our clinic between June 2012 and May 2020. The patients’ ages ranged from 0 to 205 months, with a mean of 60.59 ± 46.44 months. Of the 3849 pediatric cardiac surgery patients we screened, 162 had neurological complications in the early period (the first 10 days after surgery). The incidence was calculated as 4.2%; 69 patients (42.6%) experienced seizures, 17 (10.5%) experienced confusion, 39 (24.1%) had stupor, and 37 (22.8%) had hemiparesis. Of the patients who developed neurological complications, 54 (33.3%) died. Patients with neurological complications were divided into 3 groups: strokes (n = 90), intracranial bleeding (n = 37), and no radiological results (n = 35). Thirty-four patients (37.8%) in the stroke group died, as did 15 (40%) in the bleeding group, and 5 (14.3%) in the no radiological results group. Conclusions Studies on neurological complications after pediatric heart surgery in the literature are currently insufficient. We think that this study will contribute to a more detailed discussion of the issue. Responses to neurological events and treatment in the pediatric group may differ compared to the adult age group. Primary prevention methods should be the main approach in combating neurological complications; their formation mechanisms should be carefully monitored and preventive treatment strategies should be developed.

Short term Neurological Complications After Surgical Correction in Children with Congenital Heart Disease: A Single Center Study

“…Cerebrovascular events were reported in 9.8% patients in our study diagnosed either clinically and/or radiologically. Lower incidence of occurrence of strokes were reported by others who reported the rate of stroke development to be 0.5 and 2.3% among all patients who underwent surgery (10,12). It occurs secondary to intracardiac and extracardiac stasis or altered vascular surfaces (15,16).…”

“…Upon studying the risk for theses complications, we found that it occurred in 15.2% of patients who underwent congenital heart disease surgery in our postoperative cardiothoracic PICU. The risk of developing neurological events declined across the years from 32% to 4.2% among patients undergoing surgical correction of CHD (6,9,10). This large difference reflects the great improvement in the operative techniques over years resulting in significant decline in the neurological sequelae.…”

Incidence of neurological complications following pediatric heart surgery and its association with neutrophil‐to‐lymphocyte ratio

“…Furthermore, 69 of those 162 patients (42.6%) presented with seizures. 18 Of note, the authors suggested that developing neurological complications soon after surgery was significantly associated with increasing the risk of mortality. They, like us, believed the importance of neurological complications in the prognosis of those children, and that studies in this important area are lacking.…”

“…While they looked for factors affecting mortality, we looked for factors in occurrence of those neurological events, with focus on neutrophile‐to‐lymphocyte ratio. 18 Likewise, Ghosh et al studied the seizure risk factors in 247 infants and neonates <3 months with congenital heart disease in the United States in 2020. According to the results, 2.4% developed seizures in the early preoperative period, 1.6% early postoperative period, and 5.3% in the late postoperative.…”

“…However, according to their findings, lower mean age and weight of the patients were not associated with the increased mortality risk. 18 A recent retrospective cohort study aimed to investigate the effect of the NLR on the outcome of open‐heart surgery with cardiopulmonary bypass (CPB) in children. 25 According to the findings, higher postoperative levels of NLR predicted longer postoperative cardiac ICU stay and delayed extubating time.…”