Perioperative Stroke in Infants Undergoing Open Heart Operations for Congenital Heart Disease

Jodi Chen, Robert A. Zimmerman, Gail P. Jarvik, Alexander Nord, Robert R. Clancy, Gil Wernovsky, Lisa M. Montenegro, Diane M. Hartman, Susan C. Nicolson, Thomas L. Spray, J. William Gaynor, Rebecca Ichord

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Background: The prevalence of perioperative stroke in infants undergoing operations for congenital heart disease has not been well described. The objectives of this study were to determine the prevalence of stroke as assessed by postoperative brain magnetic resonance imaging (MRI), characterize the neuroanatomic features of focal ischemic injury, and identify risk factors for its development. Methods: Brain MRI was performed in 122 infants 3 to 14 days after cardiac operation with cardiopulmonary bypass, with or without deep hypothermic circulatory arrest. Preoperative, intraoperative, and postoperative data were collected. Risk factors were tested by logistic regression for univariate and multivariate associations with stroke. Results: Stroke was identified in 12 of 122 patients (10%). Strokes were preoperative in 6 patients and possibly intraoperative or postoperative in the other 6 patients, and were clinically silent except in 1 patient who had clinical seizures. Arterial-occlusive and watershed infarcts were identified with equal distribution in both hemispheres. Multivariate analysis identified lower birth weight, preoperative intubation, lower intraoperative hematocrit, and higher blood pressure at admission to the cardiac intensive care unit postoperatively as significant factors associated with stroke. Prematurity, younger age at operation, duration of cardiopulmonary bypass, and use of deep hypothermic circulatory arrest were not significantly associated with stroke. Conclusions: The prevalence of stroke in infants undergoing operations for congenital heart disease was 10%, half of which occurred preoperatively. Most were clinically silent and undetected without neuroimaging. Mechanisms included thromboembolism and hypoperfusion, with patient-specific, procedure-specific, and postoperative contributions to increased risk.

Original languageEnglish (US)
Pages (from-to)823-829
Number of pages7
JournalAnnals of Thoracic Surgery
Volume88
Issue number3
DOIs
StatePublished - Sep 1 2009
Externally publishedYes

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Heart Diseases
Stroke
Deep Hypothermia Induced Circulatory Arrest
Cardiopulmonary Bypass
Magnetic Resonance Imaging
Postoperative Care
Thromboembolism
Brain
Hematocrit
Intubation
Birth Weight
Neuroimaging
Intensive Care Units
Seizures
Multivariate Analysis
Logistic Models
Hypertension
Wounds and Injuries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Perioperative Stroke in Infants Undergoing Open Heart Operations for Congenital Heart Disease. / Chen, Jodi; Zimmerman, Robert A.; Jarvik, Gail P.; Nord, Alexander; Clancy, Robert R.; Wernovsky, Gil; Montenegro, Lisa M.; Hartman, Diane M.; Nicolson, Susan C.; Spray, Thomas L.; Gaynor, J. William; Ichord, Rebecca.

In: Annals of Thoracic Surgery, Vol. 88, No. 3, 01.09.2009, p. 823-829.

Research output: Contribution to journalArticle

Chen, J, Zimmerman, RA, Jarvik, GP, Nord, A, Clancy, RR, Wernovsky, G, Montenegro, LM, Hartman, DM, Nicolson, SC, Spray, TL, Gaynor, JW & Ichord, R 2009, 'Perioperative Stroke in Infants Undergoing Open Heart Operations for Congenital Heart Disease', Annals of Thoracic Surgery, vol. 88, no. 3, pp. 823-829. https://doi.org/10.1016/j.athoracsur.2009.03.030
Chen, Jodi ; Zimmerman, Robert A. ; Jarvik, Gail P. ; Nord, Alexander ; Clancy, Robert R. ; Wernovsky, Gil ; Montenegro, Lisa M. ; Hartman, Diane M. ; Nicolson, Susan C. ; Spray, Thomas L. ; Gaynor, J. William ; Ichord, Rebecca. / Perioperative Stroke in Infants Undergoing Open Heart Operations for Congenital Heart Disease. In: Annals of Thoracic Surgery. 2009 ; Vol. 88, No. 3. pp. 823-829.
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AU - Zimmerman, Robert A.

AU - Jarvik, Gail P.

AU - Nord, Alexander

AU - Clancy, Robert R.

AU - Wernovsky, Gil

AU - Montenegro, Lisa M.

AU - Hartman, Diane M.

AU - Nicolson, Susan C.

AU - Spray, Thomas L.

AU - Gaynor, J. William

AU - Ichord, Rebecca

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N2 - Background: The prevalence of perioperative stroke in infants undergoing operations for congenital heart disease has not been well described. The objectives of this study were to determine the prevalence of stroke as assessed by postoperative brain magnetic resonance imaging (MRI), characterize the neuroanatomic features of focal ischemic injury, and identify risk factors for its development. Methods: Brain MRI was performed in 122 infants 3 to 14 days after cardiac operation with cardiopulmonary bypass, with or without deep hypothermic circulatory arrest. Preoperative, intraoperative, and postoperative data were collected. Risk factors were tested by logistic regression for univariate and multivariate associations with stroke. Results: Stroke was identified in 12 of 122 patients (10%). Strokes were preoperative in 6 patients and possibly intraoperative or postoperative in the other 6 patients, and were clinically silent except in 1 patient who had clinical seizures. Arterial-occlusive and watershed infarcts were identified with equal distribution in both hemispheres. Multivariate analysis identified lower birth weight, preoperative intubation, lower intraoperative hematocrit, and higher blood pressure at admission to the cardiac intensive care unit postoperatively as significant factors associated with stroke. Prematurity, younger age at operation, duration of cardiopulmonary bypass, and use of deep hypothermic circulatory arrest were not significantly associated with stroke. Conclusions: The prevalence of stroke in infants undergoing operations for congenital heart disease was 10%, half of which occurred preoperatively. Most were clinically silent and undetected without neuroimaging. Mechanisms included thromboembolism and hypoperfusion, with patient-specific, procedure-specific, and postoperative contributions to increased risk.

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