Factors influencing neurologic outcome after neonatal cardiopulmonary bypass: what we can and cannot control.
Advances in cardiopulmonary bypass and surgical techniques have led to progress in the early repair of congenital heart defects in children. However, as increasing numbers survive their initial cardiac operation, an awareness is emerging that significant early and late neurologic morbidities continue to complicate otherwise successful operative repairs. Adverse neurologic outcomes after neonatal cardiac surgery are multifactorial and relate to both fixed and modifiable mechanisms. The purpose of this review is to (1) review mechanisms of brain injury after neonatal cardiopulmonary bypass, (2) examine risk factors, and (3) speculate on how investigations may improve our understanding of neurologic injury.
Hsia
Tain-Yen
TY
Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
Gruber
Peter J
PJ
D000471:Alkalosis / Q000517:prevention & control; D001925:Brain Damage, Chronic / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000295:instrumentation; D050792:Circulatory Arrest, Deep Hypothermia Induced; D003097:Collateral Circulation; D000075202:Contraindications; D004198:Disease Susceptibility; D004618:Embolism, Air / Q000209:etiology / Q000517:prevention & control; D020022:Genetic Predisposition to Disease; D006330:Heart Defects, Congenital / Q000601:surgery; D006438:Hemodilution; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology / Q000517:prevention & control*; D007223:Infant; D007231:Infant, Newborn; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D007969:Leukomalacia, Periventricular / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016343:Monitoring, Intraoperative / Q000379:methods / Q000639:trends; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000517:prevention & control*