Brain immaturity is associated with brain injury before and after neonatal cardiac surgery with high-flow bypass and cerebral oxygenation monitoring
Open accessAbstract
Background New intraparenchymal brain injury on magnetic resonance imaging is observed in 36% to 73% of neonates after cardiac surgery with cardiopulmonary bypass. Brain immaturity in this population is common. We performed brain magnetic resonance imaging before and after neonatal cardiac surgery, using a high-flow cardiopulmonary bypass protocol, hypothesizing that brain injury on magnetic resonance imaging would be associated with brain immaturity.Methods Cardiopulmonary bypass protocol included 150 mL . kg(-1) . min(-1) flows, pH stat management, hematocrit > 30%, and high-flow antegrade cerebral perfusion. Regional brain oxygen saturation was monitored, with a treatment protocol for regional brain oxygen saturation < 50%. Brain magnetic resonance imaging, consisting of T1-, T2-, and diffusion-weighted imaging, and magnetic resonance spectroscopy were performed preoperatively, 7 days postoperatively, and at age 3 to 6 months.Results Twenty-four of 67 patients (36%) had new postoperative white matter injury, infarction, or hemorrhage, and 16% had new white matter injury. Associations with preoperative brain injury included low brain maturity score (P = .002). Postoperative white matter injury was associated with single-ventricle diagnosis (P = .02), preoperative white matter injury (P < .001), and low brain maturity score (P = .05). Low brain maturity score was also associated with more severe postoperative brain injury (P = .01). Forty-five patients had a third scan, with a 27% incidence of new minor lesions, but 58% of previous lesions had partially or completely resolved.Conclusions We observed a significant incidence of both pre- and postoperative magnetic resonance imaging abnormality and an association with brain immaturity. Many lesions resolved in the first 6 months after surgery. Timing of delivery and surgery with bypass could affect the risk of brain injury.
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There is a high incidence of acquired brain injury in neonates with congenital heart disease, and it is usually clinically silent, especially when sedation is given.
“There is a high incidence of acquired brain injury in neonates with CHD (Table II), which is, in most cases, clinically silent (especially when sedation is given 69 ), highlighting the importance of neuroimaging to detect injury in this group.”
From Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease (2017) · cites this paper as [69]
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- Authors
- Andropoulos, D. B., Hunter, J. V., Nelson, D. P., Stayer, S. A., Stark, A. R., McKenzie, E. D., Heinle, J. S., Graves, D. E., & Fraser, C. D.
- Affiliations
- Baylor College of Medicine (US)
- Corresponding author
- Andropoulos, Dean B.
- ORCID
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2010-03
- Volume
- 139
- Issue
- 3
- Pages
- 543-556
- ISSN
- 0022-5223 (ISSN-L)
- PMC
- PMC2827639
- OpenAlex
- W2079492007
- Cited by
- 318
- References
- 29
- Citations by year
- 2026: 24 · 2025: 12 · 2024: 18 · 2023: 24 · 2022: 15 · 2021: 15 · 2020: 19 · 2019: 25 · 2018: 22 · 2017: 21 · 2016: 19 · 2015: 17 · 2014: 17 · 2013: 26 · 2012: 19
- FWCI
- 14.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Dana Foundation
- Texas Children's Hospital
- National Institutes of Health (RR-00188)
- National Center for Research Resources (M01RR000188)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R21HD055501)
- Topics
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
- Keywords
- neonatal cardiac surgery, cardiopulmonary bypass, brain immaturity, antegrade cerebral perfusion, white matter injury, cerebral infarction, cerebral hemorrhage, single ventricle, postoperative brain injury, lesion resolution, timing of surgery
- MeSH terms
- Brain, Brain Diseases, Cardiopulmonary Bypass, Cardiac Surgical Procedures, Humans, Infant, Newborn, Magnetic Resonance Imaging, Monitoring, Physiologic, Oxygen, Prospective Studies
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