Increasing duration of deep hypothermic circulatory arrest is associated with an increased incidence of postoperative electroencephalographic seizures.

Increasing duration of deep hypothermic circulatory arrest is associated with an increased incidence of postoperative electroencephalographic seizures.

MedLine Citation:	PMID: 16256779 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	OBJECTIVE: Electroencephalographic seizures have been shown to occur in 5% to 20% of neonates and infants after biventricular repair of a variety of cardiac defects. Occurrence of a seizure is a predictor of adverse long-term neurodevelopmental sequelae. The contemporary incidence of postoperative seizures after repair of cardiac defects such as hypoplastic left heart syndrome and other forms of single ventricle is not known. METHODS: A prospective study of 178 patients less than 6 months of age undergoing cardiopulmonary bypass with or without deep hypothermic circulatory arrest (DHCA) was conducted at a single institution from September 2001 through March 2003 to identify postoperative seizures assessed by 48-hour continuous video electroencephalographic monitoring. RESULTS: Cardiac defects included transposition of the great arteries with or without a ventricular septal defect (n = 12), ventricular septal defect with or without coarctation (n = 28), tetralogy of Fallot (n = 24), hypoplastic left heart syndrome or variant (n = 60), other functional single ventricle (n = 14), and other defects suitable for biventricular repair (n = 40). Median age at the time of the operation was 7 days (range, 1-188 days) and was 30 days or less in 110 (62%) patients. DHCA was used in 117 (66%) patients, with multiple episodes in 9 patients. Median total duration of DHCA was 40 minutes (range, 1-90 minutes). Electroencephalographic seizures were identified in 20 (11.2%) patients. Seizures occurred in 15 (14%) of 110 neonates and 5 (7%) of 68 older infants. Seizures occurred in 1 (4%) of 24 patients with tetralogy of Fallot, 1 (8%) of 12 with transposition of the great arteries, and 11 (18%) of 60 with hypoplastic left heart syndrome or variant. By stepwise logistic regression analysis, once increasing duration of total DHCA (P = .001) was considered, no other variable improved prediction of occurrence of a seizure. Patients with DHCA duration of more than 40 minutes had an increased incidence of seizures (14/58 [24.1%]) compared with those with a DHCA duration of 40 minutes or less (4/59 [6.8%], P = .04). The incidence of seizures for patients with a DHCA duration of 40 minutes or less was not significantly different from those in whom DHCA was not used (2/61 [3.3%], P = .38). CONCLUSIONS: In the current era, continuous electroencephalographic monitoring demonstrates early postoperative seizures in 11.2% of a heterogeneous cohort of neonates and infants with complex congenital heart defects. Increasing duration of DHCA was identified as a predictor of seizures. However, the incidence of seizures in children with limited duration of DHCA was similar to that in infants undergoing continuous cardiopulmonary bypass alone.

Authors:	J William Gaynor; Susan C Nicolson; Gail P Jarvik; Gil Wernovsky; Lisa M Montenegro; Nancy B Burnham; Diane M Hartman; Andy Louie; Thomas L Spray; Robert R Clancy
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Publication Detail:	Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. Date: 2005-10-13
Journal Detail:	Title: The Journal of thoracic and cardiovascular surgery Volume: 130 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2005 Nov
Date Detail:	Created Date: 2005-10-31 Completed Date: 2005-12-29 Revised Date: 2011-09-26
Medline Journal Info:	Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States
Other Details:	Languages: eng Pagination: 1278-86 Citation Subset: AIM; IM
Affiliation:	Division of Cardiothoracic Surgery, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa 19104, USA. gaynor@email.chop.edu
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MeSH Terms
Descriptor/Qualifier:	Adolescent Cardiopulmonary Bypass / adverse effects* Child Child, Preschool Circulatory Arrest, Deep Hypothermia Induced / adverse effects* Electroencephalography Female Humans Incidence Infant Infant, Newborn Male Prospective Studies Seizures / diagnosis, epidemiology, etiology Time Factors
Grant Support
ID/Acronym/Agency:	HL071834/HL/NHLBI NIH HHS; R01 HL071834-01A1/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:	J Thorac Cardiovasc Surg. 2005 Nov;130(5):1236 [PMID: 16256773 ]

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