Improved survival of children with congenital heart disease has led to increasing focus on neurodevelopmental outcome, as close to half of the infants undergoing cardiac surgery are affected by neurodevelopmental disability. Stroke is particularly important as it frequently results in permanent neurologic sequelae. The aim of this study was to investigate risk factors for peri-procedural arterial ischaemic stroke (AIS) in children with cardiac disease. A retrospective case–control analysis of children aged <18 years with radiologically confirmed AIS following a cardiac procedure admitted to the Royal Children’s Hospital Melbourne between 1993 and 2010. Each case was matched with two controls with similar cardiac diagnosis, procedure type, age and date of procedure. Demographics and peri-procedural data were collected from medical records and departmental database. Fifty-two cases were identified. Multivariable analysis identified post-procedural infection (OR 6.1, CI 1.3–27, p = 0.017) and length of ICU stay (OR 4.0, CI 1.4–11, p = 0.009) as risk factors for AIS. Although the study is limited to a single-centre cohort, length of ICU stay and post-procedural infection were identified as risk factors for AIS. These findings demonstrate these factors to be important areas to focus attention for stroke prevention in children with cardiac disease.
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All phases of this study were supported by the Brain Foundation Australia. Dr.Asakai is also supported by Nissan Australia. Dr.Cardamone is also supported by Uncle Bob’s Neurology fellowship. The Heart Research Group is supported by RCH 1000, RCH Foundation and Big W. The MCRI is supported by the Victorian Government’s Operational Infrastructure Support Program.
This study was supported by the Brain Foundation Australia.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
Bellinger DC, Jonas RA, Rappaport LA et al (1995) Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. N Engl J Med 332:549–555CrossRefPubMedGoogle Scholar
Hervey-Jumper SL, Annich GM, Yancon AR et al (2011) Neurological complications of extracorporeal membrane oxygenation in children. J Neurosurg 7:338–344. doi:10.3171/2011.1.PEDS10443Google Scholar
Barrett CS, Bratton SL, Salvin JW et al (2009) Neurological injury after extracorporeal membrane oxygenation use to aid pediatric cardiopulmonary resuscitation. Pediatr Crit Care Med 10:445–451CrossRefPubMedGoogle Scholar
Cengiz P, Seidel K, Rycus PT et al (2005) Central nervous system complications during pediatric extracorporeal life support: incidence and risk factors*. Crit Care Med 33:2817–2824CrossRefPubMedGoogle Scholar
Beca J, Gunn J, Coleman L et al (2009) Pre-operative brain injury in newborn infantswith transposition of the great arteries occursat rates similar to other complex congenital heart disease and is not related to balloon atrial septostomy. JAC 53:1807–1811. doi:10.1016/j.jacc.2009.01.061Google Scholar