title: Increasing duration of deep hypothermic circulatory arrest is associated with an increased incidence of postoperative electroencephalographic seizures.
abstract: OBJECTIVE
  Electroencephalographic seizures have been shown to occur in 5% to 20% of neonates and infants after biventricular repair of a variety of cardiac defects. Occurrence of a seizure is a predictor of adverse long-term neurodevelopmental sequelae. The contemporary incidence of postoperative seizures after repair of cardiac defects such as hypoplastic left heart syndrome and other forms of single ventricle is not known.
  
  
  METHODS
  A prospective study of 178 patients less than 6 months of age undergoing cardiopulmonary bypass with or without deep hypothermic circulatory arrest (DHCA) was conducted at a single institution from September 2001 through March 2003 to identify postoperative seizures assessed by 48-hour continuous video electroencephalographic monitoring.
  
  
  RESULTS
  Cardiac defects included transposition of the great arteries with or without a ventricular septal defect (n = 12), ventricular septal defect with or without coarctation (n = 28), tetralogy of Fallot (n = 24), hypoplastic left heart syndrome or variant (n = 60), other functional single ventricle (n = 14), and other defects suitable for biventricular repair (n = 40). Median age at the time of the operation was 7 days (range, 1-188 days) and was 30 days or less in 110 (62%) patients. DHCA was used in 117 (66%) patients, with multiple episodes in 9 patients. Median total duration of DHCA was 40 minutes (range, 1-90 minutes). Electroencephalographic seizures were identified in 20 (11.2%) patients. Seizures occurred in 15 (14%) of 110 neonates and 5 (7%) of 68 older infants. Seizures occurred in 1 (4%) of 24 patients with tetralogy of Fallot, 1 (8%) of 12 with transposition of the great arteries, and 11 (18%) of 60 with hypoplastic left heart syndrome or variant. By stepwise logistic regression analysis, once increasing duration of total DHCA (P = .001) was considered, no other variable improved prediction of occurrence of a seizure. Patients with DHCA duration of more than 40 minutes had an increased incidence of seizures (14/58 [24.1%]) compared with those with a DHCA duration of 40 minutes or less (4/59 [6.8%], P = .04). The incidence of seizures for patients with a DHCA duration of 40 minutes or less was not significantly different from those in whom DHCA was not used (2/61 [3.3%], P = .38).
  
  
  CONCLUSIONS
  In the current era, continuous electroencephalographic monitoring demonstrates early postoperative seizures in 11.2% of a heterogeneous cohort of neonates and infants with complex congenital heart defects. Increasing duration of DHCA was identified as a predictor of seizures. However, the incidence of seizures in children with limited duration of DHCA was similar to that in infants undergoing continuous cardiopulmonary bypass alone.
authors.affiliation: Division of Cardiothoracic Surgery, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa 19104, USA. gaynor@email.chop.edu
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.forename: Susan C
authors.initials: SC
authors.lastname: Nicolson
authors.forename: Gail P
authors.initials: GP
authors.lastname: Jarvik
authors.forename: Gil
authors.initials: G
authors.lastname: Wernovsky
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Montenegro
authors.forename: Nancy B
authors.initials: NB
authors.lastname: Burnham
authors.forename: Diane M
authors.initials: DM
authors.lastname: Hartman
authors.forename: Andy
authors.initials: A
authors.lastname: Louie
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.forename: Robert R
authors.initials: RR
authors.lastname: Clancy
mesh_terms: D000293:Adolescent; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012640:Seizures / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D013997:Time Factors