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A retrospective study of perioperative clinical seizures and epilepsy in children after operation for CHD

Published online by Cambridge University Press:  28 December 2021

Takeshi Ikegawa Open the ORCID record for Takeshi Ikegawa [Opens in a new window] ,
Shin Ono Open the ORCID record for Shin Ono [Opens in a new window] ,
Kouji Yamamoto ,
Mikihiro Shimizu ,
Sadamitsu Yanagi ,
Ki-Sung Kim ,
Yasuhiro Ichikawa Open the ORCID record for Yasuhiro Ichikawa [Opens in a new window]  and
Hideaki Ueda
Takeshi Ikegawa
Affiliation:
Department of Cardiology, Kanagawa Children’s Medical Center, Kanagawa, Japan
Shin Ono*
Affiliation:
Department of Cardiology, Kanagawa Children’s Medical Center, Kanagawa, Japan
Kouji Yamamoto
Affiliation:
Department of Biostatistics, Yokohama City University School of Medicine, Kanagawa, Japan
Mikihiro Shimizu
Affiliation:
Department of Biostatistics, Yokohama City University School of Medicine, Kanagawa, Japan
Sadamitsu Yanagi
Affiliation:
Department of Cardiology, Kanagawa Children’s Medical Center, Kanagawa, Japan
Ki-Sung Kim
Affiliation:
Department of Cardiology, Kanagawa Children’s Medical Center, Kanagawa, Japan
Yasuhiro Ichikawa
Affiliation:
Department of Cardiology, Kanagawa Children’s Medical Center, Kanagawa, Japan
Hideaki Ueda
Affiliation:
Department of Cardiology, Kanagawa Children’s Medical Center, Kanagawa, Japan
*
Author for correspondence: S. Ono, Department of Cardiology, Kanagawa Children’s Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa, Japan. Tel: +81-45-711-2351; Fax: +81-45-721-3324. E-mail: sono@kcmc.jp
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Abstract

This study investigated the incidence and risk factors of perioperative clinical seizure and epilepsy in children after operation for CHD. We included 777 consecutive children who underwent operation from January 2013 to December 2016 at Kanagawa Children’s Medical Center, Kanagawa, Japan. Perinatal, perioperative, and follow-up medical data were collected. Elastic net regression and mediation analysis were performed to investigate risk factors of perioperative clinical seizure and epilepsy. Anatomic CHD classification was performed based on the preoperative echocardiograms; cardiac surgery was evaluated using Risk Adjustment in Congenital Heart Surgery 1. Twenty-three (3.0%) and 15 (1.9%) patients experienced perioperative clinical seizure and epilepsy, respectively. Partial regression coefficient with epilepsy as the objective variable for anatomical CHD classification, Risk Adjustment in Congenital Heart Surgery 1, and the number of surgeries was 0.367, 0.014, and 0.142, respectively. The proportion of indirect effects on epilepsy via perioperative clinical seizure was 22.0, 21.0, and 33.0%, respectively. The 15 patients with epilepsy included eight cases with cerebral infarction, two cases with cerebral haemorrhage, and three cases with hypoxic-ischaemic encephalopathy; white matter integrity was not found. Anatomical complexity of CHD, high-risk cardiac surgery, and multiple cardiac surgeries were identified as potential risk factors for developing epilepsy, with a low rate of indirect involvement via perioperative clinical seizure and a high rate of direct involvement independently of perioperative clinical seizure. Unlike white matter integrity, stroke and hypoxic-ischaemic encephalopathy were identified as potential factors for developing epilepsy.

Keywords

CHDperioperative clinical seizurecardiac surgeryepilepsy
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 11 , November 2022 , pp. 1807 - 1813
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Helmers, SL, Wypij, D, Constantinou, JE, et al. Perioperative electroencephalographic seizures in infants undergoing repair of complex congenital cardiac defects. Electroencephalogr Clin Neurophysiol 1997; 102: 27–36.CrossRefGoogle ScholarPubMed
Ehyai, A, Fenichel, GM, Bender, HW Jr. Incidence and prognosis of seizures in infants after cardiac surgery with profound hypothermia and circulatory arrest. JAMA 1984; 252: 3165–3167.CrossRefGoogle ScholarPubMed
Rappaport, LA, Wypij, D, Bellinger, DC, et al. Relation of seizures after cardiac surgery in early infancy to neurodevelopmental outcome. Circulation 1998; 97: 773–779.CrossRefGoogle ScholarPubMed
Billett, J, Cowie, MR, Gatzoulis, MA, Vonder Muhll, IF, Majeed, A. Comorbidity, healthcare utilisation and process of care measures in patients with congenital heart disease in the UK: cross-sectional, population-based study with case-control analysis. Heart 2008; 94: 1194–1199.CrossRefGoogle ScholarPubMed
Leisner, MZ, Madsen, NL, Ostergaard, JR, Woo, JG, Marino, BS, Olsen, MS. Congenital heart defects and risk of epilepsy: a population-based cohort study. Circulation 2016; 134: 1689–1691.CrossRefGoogle ScholarPubMed
Clancy, RR, McGaurn, SA, Wernovsky, G, 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.CrossRefGoogle ScholarPubMed
Jenkins, KJ, Gauvreau, K, Newburger, JW, et al. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110–118.CrossRefGoogle ScholarPubMed
Zou, H, Hastie, T. Regularization and variable selection via the elastic net. J R Stat Soc Series B 2005; 67: 301–320.CrossRefGoogle Scholar
Imai, K, Keele, L, Tingley, D. A general approach to causal mediation analysis. Psychol Methods 2010; 15: 309–334.CrossRefGoogle ScholarPubMed
Imai, K, Keele, L, Tingley, D, Yamamoto, T. Unpacking the black box of causality: learning about causal mechanisms from experimental and observational studies. Am Political Sci Rev 2011; 105: 765–789.CrossRefGoogle Scholar
Imai, K, Keele, L, Tingley, D, Yamamoto, T. Experimental designs for identifying causal mechanisms. J R Stat Soc Series A 2013; 176: 5–51.CrossRefGoogle Scholar
Friedman, J, Hastie, T, Tibshirani, R. Regularization paths for generalized linear models via coordinate descent. J Stat Softw 2010; 33: 1–22.CrossRefGoogle ScholarPubMed
Tingley, D, Yamamoto, T, Hirose, K, Keele, L, Imai, K. Mediation: R package for causal mediation analysis. J Stat Softw 2014; 59: 1–38.CrossRefGoogle Scholar
Desnous, B, Lenoir, M, Doussau, A, et al. Epilepsy and seizures in children with congenital heart disease: a prospective study. Seizure 2019; 64: 50–53.CrossRefGoogle ScholarPubMed
Mebius, MJ, Kooi, EMW, Bilardo, CM, Bos, AF. Brain injury and neurodevelopmental outcome in congenital heart disease: a systematic review. Pediatrics 2017; 140: e20164055.CrossRefGoogle ScholarPubMed
Peyvandi, S, Donofrio, MT. Circulatory changes and cerebral blood flow and oxygenation during transition in newborns with congenital heart disease. Semin Pediatr Neurol 2018; 28: 38–47.CrossRefGoogle ScholarPubMed
Hövels-Gürich, HH. Factors influencing neurodevelopment after cardiac surgery during infancy. Front Pediatr 2016; 4: 137.CrossRefGoogle ScholarPubMed
Dimitropoulos, A, McQuillen, PS, Sethi, V, et al. Brain injury and development in newborns with critical congenital heart disease. Neurology 2013; 81: 241–248.CrossRefGoogle ScholarPubMed
Andropoulos, DB, Hunter, JV, Nelson, DP, et al. Brain immaturity is associated with brain injury before and after neonatal cardiac surgery with high-flow bypass and cerebral oxygenation monitoring. J Thorac Cardiovasc Surg 2010; 139: 543–556.CrossRefGoogle ScholarPubMed
Wang, Y, Liu, G, Hong, D, Chen, F, Ji, X, Cao, G. White matter injury in ischemic stroke. Prog Neurobiol 2016; 141: 45–60.CrossRefGoogle ScholarPubMed