Complicaciones neurológicas en el postoperatorio inmediato de cirugía cardiaca: todavía un largo camino por recorrer

• Autores: Alejandro Ávila Álvarez, I. González-Rivera, Ángela Ferrer Barba, Francisco Portela Torrón, E. González-Garcia, José Luis Fernández Trisac, Carmen Ramil Fraga
• Localización: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría ( AEP ), ISSN-e 1696-4608, ISSN 1695-4033, Vol. 76, Nº. 4, 2012, págs. 192-198
• Idioma: español
• Títulos paralelos:
  • Acute neurological complications after pediatric cardiac surgery: still a long way to go
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• Resumen

  • Introduction There has been an increasing concern over the neurological complications associated with congenital heart disease and cardiac surgery.

    Material and methods We performed a retrospective, case-control, observational review of the postoperative period in the intensive care unit of patients undergoing cardiac surgery over the past 10 years. We selected 2 control patients for each case, matched for surgical complexity.

    Results A total of 900 patients were reviewed. We found 38 neurological complications (4.2%), of which 21 (55.3%) were in the peripheral nervous system and 17 (44.7%) in the central nervous system. The complications involving the central nervous system (1.9% of total) consisted of 8 seizures, 4 cerebrovascular accidents, 4 hypoxic-ischemic encephalopathy events, and 1 reversible neurological deficit. At the time of discharge, 35.3% were symptomatic and 17.6% had died. Patients with neurological complications had a longer bypass time (P=.009), longer aortic cross time (P=.012), longer hospitalization in intensive care (P=.001), longer duration of mechanical ventilation (P=.004) and an increased number of days under inotropic support (P=.001).

    Conclusions Our incidence of neurological complications after cardiac surgery is similar to that previously described. Clinical seizures are the most common complication. Central nervous system complications are associated with a higher morbidity and hospitalization time. Units caring for patients with congenital heart disease must implement neurological monitoring during and after cardiac surgery to prevent and to detect these complications earlier.