Postoperative Neurological Deficits with Incidence and the Various Arterial Territories Involved in Patients Undergoing Congenital Cardiac Surgery: A Single-center Analysis

Abstract

Introduction: The incidence and pattern of neurological complications after congenital cardiac surgery have been changing over the years due to improvement in surgical technique and perioperative management. The aim of this study was to evaluate the incidence and pattern of neurological injury in our institute. Materials and Methods: We retrospectively reviewed all pediatric patients who underwent noncontrast computed tomography of the brain for suspected postoperative neurological injury occurring during the 1st week after pediatric cardiac surgery between April 2016 and February 2020. We identified neurological injury as patients having ischemic infarct and intracranial hemorrhage. Results: A total of 2971 pediatric cardiac surgeries were performed at our institute. Sixty-seven patients (2.25%) developed neurological injury. Fifty-five patients (82%) developed ischemic infarct while 12 patients (18%) had intracranial hemorrhagic. Pattern of ischemic infarct included global hypoxic injury in 30 patients (54.5%), posterior cerebral artery territory in 9 patients (16.3%), middle cerebral artery territory in 8 patients (14.5%), multiterritory involvement in 5 patients (9.0%), and anterior cerebral artery territory in 3 patients (5.4%). In patients with intracranial hemorrhage, 5 patients (7.4%) developed subarachnoid hemorrhage (SAH), 4 patients (5.9%) developed subdural hemorrhage, and 3 patients (4.4%) developed intraparenchymal hemorrhage. Conclusions: Neurological complication accounts for significant morbidity and mortality after congenital cardiac surgery. In our study, ischemic infarct accounted for 82% cases. In ischemic infarct, global ischemia was the most common type and carried high risk of mortality. In hemorrhage group, SAH was the most common finding. Nevertheless, the aim of this study was to characterize the current incidence of acute clinically evident neurologic complications in children undergoing congenital cardiac surgery in a tertiary hospital, although acute neurologic morbidity appears to be appreciably lower than in the past at our institution.