Abstract

Objective: To study the incidence, risk factors and spectrum of acute neurological complications associated with congenital heart disease surgery.

Material and Methods: This is a retrospective case-control analysis of the intra-operative and immediate postoperative period of children underwent cardiac surgery from January 2011 to December 2015. We selected 2 control patients for each case, matched for surgical complexity.

Result: During the 5 year-study period, a total of 2535 patients were reviewed. We found 117 patients with neurological complications (4.6%), of which (77.7%) were in the central nervous system and (22.3%) in the peripheral nervous system. The complications involving the central nervous system include: clinical seizures (N=47), intracranial bleed (N=29), cerebrovascular accidents (N=11), hypoxic-ischemic encephalopathy events (N=12), neuro-ophthalmic defects (N=21), spinal cord infarction (N=2), cranial nerve palsy (N=2), transient encephalopathy (N=13), transient dystonia/choreoathetosis (N=4) and other neurological deficit (N=19).The complications involving the peripheral nervous system include: neuropathy/myopathy (N=3), phrenic nerve palsy (N=29),vocal cord palsy(N=13) and Horner syndrome (N=1). Mortality was 2.5% (3 patients).

Patients with neurological complications had a complex cardiac lesion, longer bypass time (p=0,008), longer aortic cross time (p=0,001), longer hospitalization in intensive care (p=0,001), longer duration of mechanical ventilation (p=0,004) and increased number of days under ionotropic support (p=0,001).

Conclusion: Our incidence of neurological complications in the context of pediatric cardiac surgery is similar to other studies, which is still high with high morbidity. Units caring for patients with congenital heart disease must implement neurological monitoring during and after cardiac surgery to prevent and to detect these complications earlier. Psychomotor and cognitive development should be also assessed before and after surgery and In the future, large multicenter studies to examine long-term neurocognitive and developmental outcomes in these children will be necessary to fully evaluate the efficacy of our neuroprotective measures.