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Ann Thorac Surg 2003;76:576-580
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

Early postoperative prediction of cerebral damage after pediatric cardiac surgery

Gerhard Trittenwein, MDa*, Alessandra Nardi, PhDd, Heike Pansi, MDb, Johann Golej, MDa, Gudrun Burda, MDa, Michael Hermon, MDa, Harald Boigner, MDa, Gregor Wollenek, MDc

a Department of Neonatology and Pediatric Critical Care, PICU, Vienna, Austria
b ECMO Project, Vienna, Austria
c Department of Cardiac Surgery, Vienna, Austria
d Department of Medical Computer Sciences, University of Vienna, Vienna, Austria

Accepted for publication February 27, 2003.

* Address reprint requests to Dr Trittenwein, Pediatric Intensive Care Unit, University Children’s Hospital Vienna, Waehringerguertel 18-20, A-1090, Wien, Austria.
e-mail: g.trittenwein{at}a1.net

BACKGROUND: Cerebral damage is a serious complication of pediatric cardiac surgery. Early prediction of actual risk can be useful in counseling of parents, and in early diagnosis and rehabilitation therapy. Also, if all children at risk could be identified therapeutic strategies to limit perioperative cerebral damage might be developed. The aim of this study is to create a mathematical model to predict risk of neurologic sequelae within 24 hours after surgery using simple and readily available clinical measurements.

METHODS: The hospital records of 534 children after cardiac surgery were reviewed. Variables examined were age at operation, diagnosis, use of cardiopulmonary bypass, arterial and central venous oxygen saturation, serum glucose, lactate and creatine kinase, mean arterial pressure, and body temperature. The endpoint for each study patient was the occurence or lack of occurence of seizures, movement or developmental disorders, cerebral hemorrhage, infarction, hydrocephalus, or marked cerebral atrophy. Univariate and multivariate regression analyses were used to evaluate the predictive power of the investigated factors as well as to create a predictive model.

RESULTS: In 6.26% of children symptoms of cerebral damage were found. Significant risk factors were age at surgery, more complex malformations, metabolic acidosis, and increased lactate (odds ratio: age, 0.882/yr [0.772–1.008]; complex malformations, 10.32 [1.32–80.28]; arterial pH more than 7.35 to 0.4 [0.18–0.89]; lactate -1.018 per mg/dL [1.006–1.03]).

CONCLUSIONS: It is possible to quantify the risk of appearance of symptoms of cerebral damage after cardiac surgery within 24 hours using simple and readily available clinical measurements.




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