The Journal of Thoracic and Cardiovascular Surgery
Volume 130, Issue 5 , Pages 1278-1286 , November 2005

Increasing duration of deep hypothermic circulatory arrest is associated with an increased incidence of postoperative electroencephalographic seizures

Read at the Eighty-fourth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 25-28, 2004.

  • J. William Gaynor, MD

      Affiliations

    • Division of Cardiothoracic Surgery, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pa
    • Corresponding Author InformationAddress for reprints: J. William Gaynor, MD, Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Suite 8527, Philadelphia, PA 19104
    • ,
  • Susan C. Nicolson, MD

      Affiliations

    • Division of Cardiothoracic Anesthesiology, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pa
    • ,
  • Gail P. Jarvik, MD, PhD

      Affiliations

    • Department of Medicine (Medical Genetics), University of Washington, Seattle Wash
    • ,
  • Gil Wernovsky, MD

      Affiliations

    • Division of Pediatric Cardiology, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pa
    • ,
  • Lisa M. Montenegro, MD

      Affiliations

    • Division of Cardiothoracic Anesthesiology, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pa
    • ,
  • Nancy B. Burnham, RN, MSN

      Affiliations

    • Division of Cardiothoracic Surgery, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pa
    • ,
  • Diane M. Hartman, RN

      Affiliations

    • Division of Cardiothoracic Surgery, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pa
    • ,
  • Andy Louie

      Affiliations

    • Department of Medicine (Medical Genetics), University of Washington, Seattle Wash
    • ,
  • Thomas L. Spray, MD

      Affiliations

    • Division of Cardiothoracic Surgery, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pa
    • ,
  • Robert R. Clancy, MD

      Affiliations

    • Division of Neurology, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pa

Received 24 April 2004 ,Revised 16 November 2004 ,Accepted 7 February 2005.

References 

  1. Newburger JW , Jonas RA , Wernovsky G , Wypij D , Hickey PR , Karl CK , et al.   Comparison of the perioperative neurologic effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery . N Engl J Med. . 1993;329:1057–1064
  2. Bellinger DC , Jonas RA , Rappaport LA , Wypij D , Wernovsky G , Kuban KCK , et al.   Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass . N Engl J Med. . 1995;332:549–555
  3. Bellinger DC , Wypij D , Kuban KC , Rappaport LA , Hickey PR , Wernovsky G , et al.   Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass . Circulation . 1999;100:526–532
  4. du Plessis AJ , Jonas RA , Wypij D , Hickey PR , Riviello J , Wessel DL , et al.   Perioperative effects of alpha-stat versus ph-stat stat strategies for deep hypothermic cardiopulmonary bypass in infants . J Thorac Cardiovasc Surg. . 1997;114:991–1001
  5. Gaynor JW , Gerdes M , Zachai EH , Bernbaum J , Wernovsky G , Clancy RR , et al.   Apolipoprotein E genotype and neurodevelopmental sequelae of infant cardiac surgery . J Thorac Cardiovasc Surg. . 2003;126:1736–1745
  6. Clancy RR , McGaurn SA , Wernovsky G , Spray TL , Norwood WI , Jacobs ML , et al.   Preoperative risk-of-death prediction model in heart surgery with deep hypothermic circulatory arrest in the neonate . J Thorac Cardiovasc Surg. . 2000;119:347–357
  7. 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;73:1752–1758
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  9. Mahle WT , Zimmerman RA , Nicolson SC , Galli K , Gaynor JW , Wernovsky G , et al.   Serial magnetic resonance imaging of the brain in newborns undergoing congenital heart surgery . Circulation . 2000;102(19 Suppl 3):III136–III141
  10. Limperopoulos C , Majnemer A , Shevell MI , Rosenblatt B , Rohlicek C , Tchervenkov C . Neurologic status of newborns with congenital heart defects before open heart surgery . Pediatrics . 1999;103:402–408
  11. Kurth CD , Steven JM , Montenegro LM , Watzman HM , Gaynor JW , Spray TL , et al.   Cerebral oxygen saturation before congenital heart surgery . Ann Thorac Surg. . 2001;72:187–192
  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
  13. Ichord R , Smith S , Licht D , Sharif U , Raffini L , Gay nor JW , et al.   Stroke and acute cerebral injuries presenting as subclinical seizures after newborn heart surgery . Ann Neurol. . 2003;54:110–111
  14. Hovels-Gurich HH , Seghaye C , Schnitker R , Wiesner M , Huber W , Minkenberg R , et al.   Long-term neurodevelopmental outcomes in school-ages children after neonatal arterial switch operation . J Thorac Cardiovasc Surg. . 2002;124:448–458
  15. Bellinger DC , Wypij D , duPlessis AJ , Rappaport LA , Jonas RA , Wernovsky G , et al.   Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries (the Boston Circulatory Arrest Trial) . J Thorac Cardiovasc Surg. . 2003;126:1385–1396
  16. Schmid R , Tandon P , Stafstrom CE , Holmes GL . Effects of neonatal seizures on subsequent seizure-induced brain injury . Neurology . 1999;53:1754–1761
  17. McCabe BK , Silveira DC , Cilio MR , Cha BH , Liu X , Sogawa Y , et al.   Reduced neurogenesis after neonatal seizures . J Neurosci. . 2001;21:2094–2103
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  20. Yager JY , Armstrong EA , Miyashita H , Wirrell EC . Prolonged neonatal seizures exacerbate hypoxic-ischemic brain damage (correlation with cerebral energy metabolism and excitatory amino acid release) . Dev Neurosci. . 2002;24:367–381
  21. Zhang G , Hsu FC , Raol YH , Coulter DA , Brooks-Kayal AR . Selective alterations of GABA A receptor subunit expression and function in hippocampal dentate granule cells after seizures in the developing brain . [abstract] Epilepsia . 2001;42(suppl 7):224
  22. Zhang G , Raol YH , Brooks-Kayal AR . Selective alteration of excitatory and inhibitory receptors and transporters in hippocampal dentate granule cells after seizures in the developing brain . Epilepsia . 2002;43(suppl 7):27
  23. Newman MF , Kirchner JL , Phillips-Bute B , Gaver V , Grocott H , Jones RH , et al.   Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery . N Engl J Med. . 2001;344:395–402
  24. Wypij D , Newburger JW , Rappaport LA , duPlessis AJ , Jonas RA , Wernovsky G , et al.   The effect of duration of deep hypothermic circulatory arrest in infant heart surgery on late neurodevelopment (the Boston Circulatory Arrest Trial) . J Thorac Cardiovasc Surg. . 2003;126: 1397–40
  25. Bellinger DC , Wypij D , du Plessis AJ , Rappaport LA , Riviello J , Jonas RA , et al.   Developmental and neurologic effects of alpha-stat versus ph-stat strategies for deep hypothermic cardiopulmonary bypass in infants . J Thorac Cardiovasc Surg. . 2001;121:374–383
  26. Ungerleider RM , Gaynor JW . The Boston Circulatory Arrest Study . J Thorac Cardiovasc Surg. . 2003;126:1397–1403

 Supported by a grant from the Fannie E. Rippel Foundation, an American Heart Association National Grant-in-Aid (9950480N), and a grant HL071834 from the National Institutes of Health.

PII: S0022-5223(05)00532-5

doi: 10.1016/j.jtcvs.2005.02.065

The Journal of Thoracic and Cardiovascular Surgery
Volume 130, Issue 5 , Pages 1278-1286 , November 2005

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