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Predictors of Neurological Outcome Following Infant Cardiac Surgery Without Deep Hypothermic Circulatory Arrest

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Abstract

The aim of this study is to describe the clinical characteristics, perioperative course and neuroimaging abnormalities of infants with congenital heart disease (CHD) undergoing heart surgery without deep hypothermic circulatory arrest (DHCA) and identify variables associated with neurological outcome. Infants with CHD undergoing open-heart surgery without DHCA between 2009 and 2017 were identified from a cardiac surgery database. Full-term infants < 10 weeks of age at the time of surgery who had both a pre- and postoperative brain magnetic resonance imaging exam (MRI) were included. Clinical characteristics and perioperative variables were collected from the electronic medical record. Brain Injury Scores (BIS) were assigned to pre- and postoperative brain MRIs. Variables were examined for association with neurological outcome at 12 months of age or greater. Forty-two infants were enrolled in the study, of whom 69% (n = 29) had a neurological assessment ≥ to 12 months of age. Adverse neurological outcome was associated with longer intensive care unit (ICU) stay (P = 0.003), lengthier mechanical ventilation (P = 0.031), modified Blalock-Taussig (MBT) shunt procedure (P = 0.005) and postoperative seizures (P = 0.005). Total BIS scores did not predict outcome but postoperative infarction and/or intraparenchymal hemorrhage (IPH) was associated with worse outcome by multivariable analysis (P = 0.018). Infants with CHD undergoing open-heart surgery without DHCA are at increased risk of worse neurological outcome when their ICU stay is prolonged, mechanical ventilation is extended, MBT shunt is performed or when postoperative seizures are present. Cerebral infarctions and IPH on postoperative MRI are also associated with worse outcome.

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Data Availability

Data sharing was not included in the IRB approval for this study. Supplemental tables are included to maximize transparency.

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Authors and Affiliations

  1. Department of Radiology, Cantonal Hospital Aarau, Aarau, Switzerland

    Agnieszka Kosiorek

  2. Division of Prenatal Diagnosis & Therapy, Department of Obstetrics and Gynecology, Justus-Liebig-University, University Hospital Giessen & Marburg, Giessen, Germany

    Agnieszka Kosiorek, Justus G. Reitz & Roland Axt-Fliedner

  3. Division of Cardiology, Children’s National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Mary T. Donofrio

  4. Departments of Surgery and Anesthesiology, Harvard Medical School, Boston Children’s Hospital, Boston, MA, USA

    David Zurakowski

  5. Pediatric and Fetal Cardiologist, Pediatric Cardiology Associates, LLC, Syracuse, NY, USA

    Lauren Tague

  6. Division of Diagnostic Imaging & Radiology, Departments of Radiology & Pediatrics, Children’s National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Jonathan Murnick

  7. Division of Diagnostic Imaging and Radiology, Developing Brain Institute, Children’s National Hospital, Radiology and Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Catherine Limperopoulos

  8. Division of Cardiovascular Surgery, Children’s National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Can Yerebakan

  9. Division of Pediatric Neurology, University of Maryland Medical Center, University of Maryland, School of Medicine, Baltimore, MD, 21201, USA

    Jessica L. Carpenter

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  1. Agnieszka Kosiorek
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  2. Mary T. Donofrio
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  3. David Zurakowski
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  4. Justus G. Reitz
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  5. Lauren Tague
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  8. Catherine Limperopoulos
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  9. Can Yerebakan
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  10. Jessica L. Carpenter
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Contributions

AK, CY, MTD, JGR, JLC: Substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data; drafting the article; final approval of the version to be published. DZ: Substantial contributions to conception and design, analysis and interpretation of data; drafting the article; final approval of the version to be published. LT: Substantial contributions to acquisition of data and final approval of the version to be published. RA-F: Substantial contributions to conception and design and final approval of the version to be published. JM, CL: Substantial contributions to acquisition of data, and analysis and interpretation of data; final approval of the version to be published.

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Correspondence to Jessica L. Carpenter.

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Kosiorek, A., Donofrio, M.T., Zurakowski, D. et al. Predictors of Neurological Outcome Following Infant Cardiac Surgery Without Deep Hypothermic Circulatory Arrest. Pediatr Cardiol 43, 62–73 (2022). https://doi.org/10.1007/s00246-021-02693-z

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