Abstract T P375: Risk Factors for Peri-procedural Stroke in Children With Cardiac Disease
BACKGROUND: Cardiac disease is identified in up to 30% of children with stroke, with almost one quarter occurring in the perioperative period. This has potentially devastating implications for long term neurodevelopmental outcomes. The aim of the study was to investigate risk factors of peri-procedural stroke in children with cardiac disease.
METHODS AND PATIENTS: We performed a retrospective case-control study of all children under <18 years of age who had an arterial ischemic stroke (AIS) after a cardiac procedure at a tertiary pediatric hospital between January 1993-December 2010. Each case was matched with 2 controls for cardiac diagnosis, procedure type, age and date of procedure. The following variables were analysed; (1) Procedural details: cardiopulmonary bypass (CPB) time, circulatory arrest time, intraoperative blood pressure, oxygen saturation and haemoglobin, (2) Post procedural details: length of intensive care unit stay, length of hospital stay, length of mechanical ventilation, mechanical circulatory support, complications including infection and arrhythmia, clinical parameters including blood pressure and oxygen saturation (SpO2), laboratory data including serum lactate, haemoglobin and haematocrit.
RESULTS: A total of 52 children with AIS were identified. Univariable analysis identified post-procedural infection (OR 7.3, CI 2.0-26, p=0.002) and length of ICU stay (OR 4.7, CI 1.9-12, p<0.001) to be strongly associated with AIS, followed by post-procedure arrhythmia (OR 3.0, CI 0.9-11, p=0.089), other post-procedure complications (OR 3.1, CI 1.1-8.6, p=0.029) highest post-procedure Sp02 (OR 2.4, CI 0.97-5.7, p=0.058) and previous history of cardiac catheterization (OR 2.2, CI 0.9-4.9, p=0.071). In a multivariable analysis, post-procedural infection (OR 5.6, CI 1.3-15, p=0.022) and length of ICU stay (OR 3.2, CI 1.1-9, p=0.031) were identified as risk factors for AIS.
Conclusion: Although the study is limited to a single center cohort, length of ICU stay and post procedural infection were identified as risk factors for AIS. These findings demonstrate these factors to be important areas to focus attention for stroke prevention in children with cardiac disease.
Author Disclosures: H. Asakai: Employment; Significant; Nissan Motor Company. B. Stojanovski: None. J.C. Galati: None. M. Cardamone: None. D. Hutchinson: None. M.M.H. Cheung: None. M.T. Mackay: Research Grant; Modest; National Stroke Foundation of Australia, Murdocu Childrens Research Institute.
- © 2015 by American Heart Association, Inc.