The impact of cerebral embolization during infant cardiac surgery on neurodevelopmental outcomes at intermediate follow-up.
Document Type
Article
Publication Date
9-1-2014
Identifier
DOI: 10.1177/0267659114524469
Abstract
Cerebral embolization during pediatric cardiac surgery may be an underappreciated source of subsequent neurodevelopmental impairment. Transcranial Doppler ultrasound is a neuromonitoring tool that can provide intraoperative surveillance for cerebral embolization. We hypothesized that increased cerebral embolic signals detected during infant cardiac surgery would be associated with worse neurodevelopmental outcomes at follow-up. A study group of 24 children who underwent infant cardiac surgery with transcranial Doppler detection of cerebral embolic signals returned at intermediate follow-up for standardized neurodevelopmental assessment. The children were evaluated using two neurocognitive tests and the parents completed two questionnaires regarding observed behavior. Statistical analysis assessed for correlation between the number of cerebral embolic signals at surgery and the results of the neurodevelopmental assessment. Of the 67 test parameters analyzed, five showed a significant association with the number of embolic signals, yet, all in the contrary direction of the clinical hypothesis, likely representing a Type I error. Thus, in this small cohort of patients, the number of cerebral embolic signals detected during infant cardiac surgery was not shown to be associated with worse neurodevelopmental outcomes at intermediate follow-up. A larger study is probably necessary to ascertain the potential influence of cerebral embolic signals on eventual neurologic outcomes in children. The clinical relevance of cerebral embolic signals during pediatric cardiac surgery remains undetermined and deserves further investigation.
Journal Title
Perfusion
Volume
29
Issue
5
First Page
443
Last Page
449
MeSH Keywords
Cardiac Surgical Procedures; Cerebrovascular Circulation; Child Development; Cognition; Embolization, Therapeutic; Follow-Up Studies; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Ultrasonography, Doppler, Transcranial
Keywords
brain; congenital; embolization; neurodevelopmental; neuromonitoring; pediatric; transcranial Doppler
Recommended Citation
Naik, R. J., Wagner, J. B., Chowdhury, D., Barnes, M. I., Wagner, D. S., Burson, K. C., Eslinger, P. J., Clark, J. B. The impact of cerebral embolization during infant cardiac surgery on neurodevelopmental outcomes at intermediate follow-up. Perfusion 29, 443-449 (2014).
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