NEUROLOGICAL COMPLICATIONS FOLLOWING PEDIATRIC CONGENITAL CARDIAC SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS

MADHU A YADAV; REKHA A ASSADI; NEHA K KUDUMULA

doi:10.22159/ajpcr.2024.v17i1.50257

Authors

MADHU A YADAV Department of Cardiac Anaesthesia, Sri Padmavathi Children’s Heart Centre, Tirupathi, Andhra Pradesh, India
REKHA A ASSADI Balaji Clinic, Chennai, Tamil Nadu, India.
NEHA K KUDUMULA 3Clinical Trials Unit, University Hospital Limerick, Ireland

DOI:

https://doi.org/10.22159/ajpcr.2024.v17i1.50257

Keywords:

Congenital heart disease, surgery, pediatric age, neurological complications, mortality.

Abstract

Objectives: The study was designed to ascertain the incidence of neurological complications in children following cardiac surgery for congenital heart defects (CHD).

Methods: An extensive search was conducted using Medical Subject Headings in the Cochrane Controlled Trials databases, PubMed, and Embase in July 2023. Data extraction was done using a customized data extraction sheet, adhering to Cochrane’s standard methodological procedures. As the heterogeneity was high among the included studies, random-effect models were employed during the meta-analysis.

Results: Seventeen articles were included in our analysis, encompassing a total sample size of 23,930 pediatric patients who underwent congenital cardiac surgeries. The calculated incidence of neurological complications following these procedures was found to be 0.21 (95% confidence interval: 0.14–0.28). A random-effects model employing the DerSimonian-Laird estimator was utilized for the meta-analysis. The assessment of heterogeneity revealed Tau of 0.134, an I2 value of 99.63%, and an H2 value of 267.078, indicating heterogeneity (p<0.001).

Conclusion: The study highlights the substantial incidence of neurological complications following congenital cardiac surgery, with infants <1 year old being at a higher risk.

Downloads

Download data is not yet available.

References

Domi T, Edgell DS, McCrindle BW, Williams WG, Chan AK, MacGregor DL, et al. Frequency, predictors, and neurologic outcomes of vaso-occlusive strokes associated with cardiac surgery in children. Pediatrics 2008;122:1292-8. doi:10.1542/peds.2007-1459

Gunn JK, Beca J, Hunt RW, Goldsworthy M, Brizard CP, Finucane K, et al. Perioperative risk factors for impaired neurodevelopment after cardiac surgery in early infancy. Arch Dis Child 2016;101:1010-6. doi:10.1136/archdischild-2015-309449

Avila-Alvarez A, Gonzalez-Rivera I, Ferrer-Barba A, Portela-Torron F, Gonzalez-Garcia E, Fernandez-Trisac JL, et al. Complicaciones neurológicas en el postoperatorio inmediato de cirugía cardiaca: Todavía un largo camino por recorrer. An Pediatr 2012;76:192-8. doi:10.1016/j.anpedi.2011.07.018

Jafri SK, Ehsan L, Abbas Q, Ali F, Chand P, Ul Haque A. Frequency and outcome of acute neurologic complications after congenital heart disease surgery. J Pediatr Neurosci 2017;12:328-31. doi:10.4103/JPN. JPN_87_17

Menache CC, Du Plessis AJ, Wessel DL, Jonas RA, Newburger JW. Current incidence of acute neurologic complications after open-heart operations in children. Ann Thorac Surg 2002;73:1752-8. doi:10.1016/ S0003-4975(02)03534-8

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol 2009;62:e1-34. doi:10.1016/j. jclinepi.2009.06.006

Higgins JP, Green S, Cochrane Collaboration, editors. Cochrane Handbook for Systematic Reviews of Interventions. United States: Wiley-Blackwell; 2008.

Bandeira-Echtler E, Bergerhoff K, Richter B. Levothyroxine or minimally invasive therapies for benign thyroid nodules. Cochrane Database Syst Rev 2014;2014:CD004098. doi:10.1002/14651858. CD004098.pub2

Fallon P, Aparicio JM, Elliott MJ, Kirkham FJ. Incidence of neurological complications of surgery for congenital heart disease. Arch Dis Child 1995;72:418-22. doi:10.1136/adc.72.5.418

Limperopoulos C, Majnemer A, Shevell MI, Rohlicek C, Rosenblatt B, Tchervenkov C, et al. Predictors of developmental disabilities after open heart surgery in young children with congenital heart defects. J Pediatr 2002;141:51-8. doi:10.1067/mpd.2002.125227

Trittenwein G, Nardi A, Pansi H, Golej J, Burda G, Hermon M, et al. Early postoperative prediction of cerebral damage after pediatric cardiac surgery. Ann Thorac Surg 2003;76:576-80. doi:10.1016/S0003- 4975(03)00468-5 12. Galli KK, Zimmerman RA, Jarvik GP, Wernovsky G, Kuypers MK, Clancy RR, et al. Periventricular leukomalacia is common after neonatal cardiac surgery. J Thorac Cardiovasc Surg 2004;127:692-704. doi:10.1016/j.jtcvs.2003.09.053

Majnemer A, Limperopoulos C, Shevell M, Rosenblatt B, Rohlicek C, Tchervenkov C. Long-term neuromotor outcome at school entry of infants with congenital heart defects requiring open-heart surgery. J Pediatr 2006;148:72-7. doi:10.1016/j.jpeds.2005.08.036

Kansy A, Tobota Z, Maruszewski P, Maruszewski B. Analysis of 14,843 neonatal congenital heart surgical procedures in the European association for cardiothoracic surgery congenital database. Ann Thorac Surg 2010;89:1255-9. doi:10.1016/j.athoracsur.2010.01.003

Meyer S, Poryo M, Shatat M, Gortner L, Abdul-Khaliq H. The role of EEG recordings in children undergoing cardiac surgery for congenital heart disease. Wien Med Wochenschr 2017;167:251-5. doi:10.1007/ s10354-017-0576-0

Agarwal HS, Wolfram KB, Saville BR, Donahue BS, Bichell DP. Postoperative complications and association with outcomes in pediatric cardiac surgery. J Thorac Cardiovasc Surg 2014;148:609-16.e1. doi:10.1016/j.jtcvs.2013.10.031

Jordan LC, Ichord RN, Reinhartz O, Humpl T, Pruthi S, Tjossem C, et al. Neurological complications and outcomes in the berlin heart excor ® pediatric investigational device exemption trial. J Am Heart Assoc 2015;4:e001429. doi:10.1161/JAHA.114.001429

Bar-Yosef O, Greidinger D, Iskilova M, Hemi R, Tirosh T, Vardi A. Neurological deficit is predicted by S100B in children after cardiac surgery. Clin Chim Acta 2018;481:56-60. doi:10.1016/j. cca.2018.02.032

Chung MG, Guilliams KP, Wilson JL, Beslow LA, Dowling MM, Friedman NR, et al. Arterial ischemic stroke secondary to cardiac disease in neonates and children. Pediatr Neurol 2019;100:35-41. doi:10.1016/j.pediatrneurol.2019.06.008

Arslanoğlu E, Kara KA, Yiğit F, Arkan C, Uslu U, Şavluk OF, et al. Neurological complications after pediatric cardiac surgery. Cardiothorac Surg 2021;29:19. doi:10.1186/s43057-021-00056-1

Agha HM, Fathalla A, Isgro G, Cotza M. Predictors of neurological complications of pediatric post-cardiotomy extracorporeal life support. J Saudi Heart Assoc 2023;34:249-56. doi:10.37616/2212-5043.1324

Abdshah A, Mirzaaghayan M, Heidari M, Memarian S, Amanollahi M, Nazeri A, et al. Incidence of neurological complications following pediatric heart surgery and its association with neutrophil‐to‐lymphocyte ratio. Health Sci Rep 2023;6:e1077. doi:10.1002/hsr2.1077

Rohde S, Sandica E, Veen K, Miera O, Amodeo A, Napoleone CP, et al. Cerebrovascular accidents in paediatric patients supported by the Berlin Heart EXCOR. Eur J Cardiothorac Surg 2022;62:ezac381. doi:10.1093/ ejcts/ezac381

Walaa E, Imane Y, Mohamed A, Ahmed A, Aya F, Aly E. Short term neurological complications after surgical correction in children with congenital heart disease: A single center study. Pediatr Sci J 2023;3:1-10. doi:10.21608/cupsj.2022.140797.1053

Martinez-Biarge M, Jowett VC, Cowan FM, Wusthoff CJ. Neurodevelopmental outcome in children with congenital heart disease. Semin Fetal Neonatal Med 2013;18:279-85. doi:10.1016/j. siny.2013.04.006

Chaoui R, Gardiner H. Perinatal cardiology 2013. Semin Fetal Neonatal Med 2013;18:235-6. doi:10.1016/j.siny.2013.05.010

Massaro AN, El-Dib M, Glass P, Aly H. Factors associated with adverse neurodevelopmental outcomes in infants with congenital heart disease. Brain Dev 2008;30:437-46. doi:10.1016/j.braindev.2007.12.013

McQuillen PS, Miller SP. Congenital heart disease and brain development: Congenital heart disease and brain development. Ann N Y Acad Sci 2010;1184:68-86. doi:10.1111/j.1749-6632.2009.05116.x

Donofrio MT, Duplessis AJ, Limperopoulos C. Impact of congenital heart disease on fetal brain development and injury. Curr Opin Pediatr 2011;23:502-11. doi:10.1097/MOP.0b013e32834aa583

Owen M, Shevell M, Majnemer A, Limperopoulos C. Abnormal brain structure and function in newborns with complex congenital heart defects before open heart surgery: A review of the evidence. J Child Neurol 2011;26:743-55. doi:10.1177/0883073811402073