Nonischemic Postoperative Seizure Does Not Increase Mortality After Cardiac Surgery

Ivascu, Natalia S.; Gaudino, Mario; Lau, Christopher; Segal, Alan Z.; DeBois, William; Munjal, Monica; Girardi, Leonard N.

doi:10.1016/j.athoracsur.2015.02.077

Cited by 5 publications

(4 citation statements)

References 16 publications

(32 reference statements)

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“…Four of the NCSE patients subsequently died in the course of their hospital stay without showing any clinical improvement following the initiation of appropriate antiseizure medication despite the abolishment of the seizure activity [ 20 ]. Cerebral injury also accounts for the 62% mortality rate we found in patients exhibiting any type of seizure postoperatively and replicates findings by other researchers who showed that poor outcomes were primarily seen in seizure patients who concomitantly presented with new brain injury [ 3 , 8 , 18 ]. Even if there is no visible structural damage detected in the CCT images, subtle neuronal insults may occur in the context of CPB [ 21 , 22 , 23 ], which cause encephalopathy and might also induce epileptic activity in susceptible patients [ 24 , 25 ].…”

Section: Discussionsupporting

confidence: 89%

“…In this study, neurological complications potentially associated with seizure activity after cardiac surgery on CPB were also related with re-operative surgery, urgent and open-chamber procedures, renal insufficiency, cerebrovascular disease, aortic atherosclerosis, cardiopulmonary resuscitation and a prolonged duration of anesthesia causing tremendously increased morbidity and mortality [ 9 , 18 , 19 ]. In this cohort, seizures were closely linked to postoperative mortality signifying the multiple co-morbidities of these patients and the severity of the critical state these patients were in.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Nonconvulsive Status Epilepticus after Cardiac Surgery on Outcome

Skhirtladze-Dworschak

Felli

Aull‐Watschinger

et al. 2022

JCM

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Neurological complications after heart surgery are associated with tremendous morbidity and mortality. Nonconvulsive status epilepticus (NCSE), which can only be verified by EEG, may cause secondary brain damage. Its frequency and its impact on outcomes after cardiac surgery is still unclear. We collected the neurological files and clinical data of all our patients after heart surgery who, in the course of their ICU stay, had been seen by a neurologist who ordered an EEG. Within 18 months, 1457 patients had cardiac surgery on cardiopulmonary bypass. EEG was requested for 89 patients. Seizures were detected in 39 patients and NCSE was detected in 11 patients. Open heart surgery was performed in all 11 NSCE patients, of whom eight showed concomitant brain insults. None had a history of epilepsy. Despite the inhibition of seizure activity with antiseizure medication, clinical improvement was only noted in seven NCSE patients, three of whom were in cerebral performance category 2 and four in category 3 at hospital discharge. The four patients without neurological benefit subsequently died in the ICU. The occurrence of NCSE after open cardiac surgery is significant and frequently associated with brain injury. It seems prudent to perform EEG studies early to interrupt seizure activity and mitigate secondary cerebral injury.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

The Impact of Nonconvulsive Status Epilepticus after Cardiac Surgery on Outcome

Skhirtladze-Dworschak

Felli

Aull‐Watschinger

et al. 2022

JCM

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“…Regarding initial renal function, our results support earlier findings that the risk of seizures is particularly high in the small group of patients with chronic kidney disease stages 4-5. 11,12 With respect to secondary endpoints such as in-hospital and 1-year mortality, the nonsignificant differences between the TXA and non-TXA groups are in general agreement with results of the ATACAS trial. 3,13 Moreover, similar to the results of our post hoc analysis, in the ATACAS trial patients with seizure had a significantly higher risk of stroke 3 and a significantly higher risk to die within 30 days.…”

Section: Discussionsupporting

confidence: 78%

Moderate Dose of Tranexamic Acid and Complications after Valvular Heart Surgery

Hulde

Zittermann

Deutsch

et al. 2021

Thorac Cardiovasc Surg

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Background In valvular open-heart surgery, data regarding the effect of a moderate dose of tranexamic acid (TXA) on clinical outcomes are limited. Methods Out of a cohort of 13,293 patients, we performed a propensity-score-matched analysis in 6,106 patients and assessed the risk of convulsive seizures (CS, primary endpoint), stroke, renal replacement therapy, and mortality (secondary endpoints). In the entire study cohort of 13,293 patients, we also assessed the multivariable-adjusted association of CS with postoperative outcomes. Results The risk of CS was significantly higher in the TXA group (2.4%; n = 72) than in the non-TXA group (1.0%; n = 32), with a relative risk ratio (RR) of 2.28 (95% confidence interval [CI]: 1.50–3.47; p < 0.001). The risk of CS was also higher in patients receiving TXA doses ≥25 mg/kg body weight (3.7%; n = 40) than in patients receiving <25 mg/kg body weight (1.6%; n = 32; p < 0.001). Perioperative secondary clinical endpoints and 1-year mortality did not differ significantly between study groups (p-value > 0.05). Compared with non-CS patients (n = 13,000), patients with nonhemorrhagic, nonembolic CS (n = 253) revealed higher multivariable-adjusted in-hospital risks of stroke (RR: 3.82 [95% CI: 2.44–5.60; p < 0.001]) and mortality (RR: 2.07 [95% CI: 1.23–3.48; p = 0.006]), and a higher 1-year mortality risk (RR: 1.85 [95% CI: 1.42–2.41; p < 0.001]). Conclusion A moderate TXA dose was associated with a significantly higher risk of seizure, but not with other clinical complications such as stroke, renal replacement therapy, and mortality. However, in the small group of patients experiencing a seizure, the risks of stroke and short- and mid-term mortality were substantially higher than in patients not experiencing a seizure, indicating that the use of a low-dose TXA protocol (<25 mg/kg body weight) should be considered.

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“…If a postoperative seizure is associated with cerebral ischemia, there is a significant increase in postoperative morbidity and mortality. An isolated seizure without evidence for new ischemia does not seem to be related with worse outcome 42 . In our population, all patients with seizures fully recovered, except for one patient who was diagnosed with GCI on MRI.…”

Section: Epilepsymentioning

confidence: 96%

The incidence of early neurological complications after on-pump cardiac surgery: a retrospective study

Houthuys¹,

Schrijvers²,

Beersel³

et al. 2022

Acta Anaest Belg

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Background: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a significant risk for neurological complications. Reported incidence and risk factors for these complications vary significantly. Identifying risk factors could lead to preventive strategies to reduce complications and improve patient’s outcome. Objective: The study aims to assess the overall incidence and risk factors for severe early postoperative neurological complications after elective on-pump cardiac surgery. We specifically analyzed the incidence of stroke, global cerebral ischemia (GCI) and epilepsy in these patients. Methods: After getting approval from the Ethics Committee Research UZ/KU Leuven, on 14/12/2021 (s65871), we retrospectively evaluated data of 1080 adult patients after cardiac surgery with CPB between 06/2019 and 06/2021 at the University Hospitals Leuven. After exclusion of emergency procedures and patients who died before neurological evaluation, 977 patients remained for primary analysis. All data were collected from the electronic patient’s file. Primary objective was to identify the incidence of stroke, GCI and epilepsy. We defined stroke and GCI according to the American Stroke Association. Secondary endpoints were identifying independent risk-factors and assessing the impact of early neurological complications on mortality. Statistical analysis was performed using econometric and statistical modeling with python. We performed univariate logistic regression with Bonferonni correction and multivariable logistic regression with backwards elimination approach and p-value set to be <0.05. Results: The overall incidence of defined neurological complications after elective on-pump cardiac surgery at our institution was 3.17% (n=31) (stroke 2.35% (n=23), epilepsy 0.61% (n=6) and GCI 0.31% (n=3)). No statistically significant risk factors for these complications were found. In secondary analysis, patients with stroke and GCI had a higher risk of in-hospital mortality (Fisher’s exact test resulted in odds ratio 7.23 with p=0.005 and odds ratio 65.17 with p=0.003 respectively) Diabetes mellitus, preoperative atrial fibrillation, and endocarditis were also significantly related to in-hospital mortality. Conclusions: The incidence of early neurological complications after elective on-pump cardiac surgery at our institution was comparable to that reported in earlier studies. No independent risk factors for these neurological complications were found. The occurrence of stroke and GCI significantly increased in-hospital mortality which emphasizes the importance of these complications, with possible mortality benefit of early recognition and management of stroke.

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Nonischemic Postoperative Seizure Does Not Increase Mortality After Cardiac Surgery

Cited by 5 publications

References 16 publications

The Impact of Nonconvulsive Status Epilepticus after Cardiac Surgery on Outcome

The Impact of Nonconvulsive Status Epilepticus after Cardiac Surgery on Outcome

Moderate Dose of Tranexamic Acid and Complications after Valvular Heart Surgery

The incidence of early neurological complications after on-pump cardiac surgery: a retrospective study

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