Perioperative Complications and Clinical Outcomes in Patients with Congenital Cyanotic Heart Disease Undergoing Surgery for Brain Abscess

Abstract

Background Brain abscess is a rare neurological complication in patients with congenital cyanotic heart disease (CCHD). Perioperative complications are high in patients with CCHD. We evaluated incidence of and risk factors for perioperative complications and their impact on clinical outcomes in patients with CCHD undergoing brain abscess surgery with monitored anesthesia care (MAC) or general anesthesia (GA). Methods In this single-center retrospective cohort study, data were collected from consecutive patients with CCHD who presented with brain abscess and underwent surgery from January 2006 to December 2018. Data regarding demographics, type of CCHD, signs and symptoms of brain abscess and CCHD, type and duration of surgery, details of anesthesia, perioperative complications, and clinical outcomes were collected. Chi-square test was used to analyze nonparametric data and student t-test for parametric data. Results Of the 402 patients with brain abscess, data of 34 patients with CCHD who underwent brain abscess surgery were analyzed. The mean age at presentation of brain abscess was 15.8 ± 10.8 years and duration of symptoms was 17.3 ± 15.5 days. The incidence of perioperative complications was 82.4% (28/34 patients). Seven patients (20.6%) developed perioperative cyanotic spells which led to cardiac arrest in 5 patients (14.7%) and death in 2 patients (5.9%). Patients on cardiac medications and with high heart rate had higher incidence of cyanotic spells and mortality. Technique of anesthesia did not affect cardiac and neurological outcome. Conclusions Perioperative complications are high after brain abscess surgery in patients with CCHD. Perioperative characteristics and outcomes were similar with MAC and GA techniques.

Cerebral abscess as a neurosurgical emergency in Eisenmenger syndrome: illustrative case

“…In their cohort of 402 patients with brain abscesses, Vimala et al found that 34 patients had congenital cyanotic heart disease. 5 Of these 34 patients, 10 had Eisenmenger syndrome. Daliento et al reported a retrospective cohort of 188 patients with Eisenmenger syndrome, of whom 7 (3.7%) developed a cerebral abscess.…”

“…Out of 10, 8 were case reports and 2 were retrospective cohort studies, making a total of 25 patients reported in the literature who had Eisenmenger syndrome and cerebral abscess (Table 1). [4][5][6][7][8][9][10][11][12][13] The retrospective cohort study by Daliento et al included a cohort of patients with Eisenmenger syndrome, 7 of whom had cerebral abscess. They commented that although cerebral abscess in patients with Eisenmenger syndrome had significant morbidity, they did not affect mortality.…”

Clinical and Laboratory Markers of Brain Abscess in Tetralogy of Fallot (‘BA-TOF’ Score): Results of a Case–Control Study and Implications for Community Surveillance

“…Institution of early treatment would in turn effectively improve clinical outcomes in a population already disadvantaged by high morbidity and mortality rates. 36 It may be cautioned that this study has the inherent limitations of a retrospective analysis, and that the model is specific to a subset of the Indian population. This is a preliminary study, and its findings will need prospective validation in larger samples and other populations before it can be widely implemented.…”