Risk Factors of Perioperative Brain Injury in Children Under Two Years Undergoing Coarctation Repair

作者全名："Cheng, Min; Xu, Hong-Zhen; Zhang, Kai-Jun; Peng, Xiao-Ling; Pan, Zheng-Xia; Hu, Yue"

作者地址："[Cheng, Min; Hu, Yue] Chongqing Med Univ, Dept Neurol, Childrens Hosp, Chongqing, Peoples R China; [Cheng, Min; Xu, Hong-Zhen; Zhang, Kai-Jun; Pan, Zheng-Xia; Hu, Yue] Minist Educ, Key Lab Child Dev & Disorders, Natl Clin Res Ctr Technol Cooperat Base Child Dev, Chongqing Key Lab Pediat, Chongqing, Peoples R China; [Xu, Hong-Zhen] Chongqing Med Univ, Childrens Hosp, Dept Anesthesiol, Chongqing, Peoples R China; [Zhang, Kai-Jun] Chongqing Med Univ, Dept Cardiol, Childrens Hosp, Chongqing, Peoples R China; [Peng, Xiao-Ling] Beijing Normal Univ Hong Kong Baptist Univ United, Div Sci & Technol, Zhuhai, Guangdong, Peoples R China; [Pan, Zheng-Xia] Chongqing Med Univ, Childrens Hosp, Dept Cardiothorac Surg, Chongqing, Peoples R China; [Hu, Yue] Chongqing Med Univ, Dept Neurol, Childrens Hosp, 136,Second St Zhongshan Rd, Chongqing 400014, Peoples R China"

通信作者："Hu, Y (通讯作者)，Minist Educ, Key Lab Child Dev & Disorders, Natl Clin Res Ctr Technol Cooperat Base Child Dev, Chongqing Key Lab Pediat, Chongqing, Peoples R China.; Hu, Y (通讯作者)，Chongqing Med Univ, Dept Neurol, Childrens Hosp, 136,Second St Zhongshan Rd, Chongqing 400014, Peoples R China."

来源：PEDIATRIC NEUROLOGY

ESI学科分类：NEUROSCIENCE & BEHAVIOR

WOS号：WOS:000948085000001

JCR分区：Q1

影响因子：3.2

年份：2023

卷号：141

期号：　

开始页：109

结束页：117

文献类型：Article

关键词：Perioperative brain injury; Coarctation of the aorta; Cardiopulmonary bypass; Neurological outcome

摘要："Background: To investigate clinical manifestations and factors of perioperative brain injury (PBI) after surgical repair of coarctation of the aorta (CoA) combined with other heart malformations under car-diopulmonary bypass (CPB) in children under two years. Methods: The clinical data of 100 children undergoing CoA repair were retrospectively reviewed be-tween January 2010 and September 2021. Univariate and multivariate analyses were performed to identify factors of PBI development. Hierarchical and K-means cluster analyses were conducted to evaluate the association between hemodynamic instability and PBI. Results: Eight children developed postoperative complications, and all of them had a favorable neuro-logical outcome one year after surgery. Univariate analysis revealed eight risk factors associated with PBI. Multivariate analysis indicated operation duration (P = 0.04, odds ratio [OR], 2.93; 95% confidence in-terval [CI], 1.04 to 8.28) and pulse pressure (PP) minimum (P = 0.01; OR, 0.22; 95% CI, 0.06 to 0.76) were independently associated with PBI. The following three parameters emerged for cluster analysis: PP minimum, mean arterial pressure (MAP) dispersion, and systemic vascular resistance (SVR) average. Using cluster analysis, PBI mainly occurred in subgroups 1 (12%, three of 26) and 2 (10%, five of 48). The mean value of PP and MAP in subgroup 1 was significantly higher than in subgroup 2. The mean SVR in subgroup 1 was the highest. The lowest PP minimum, MAP, and SVR were observed in subgroup 2. Conclusion: Lower PP minimum and longer operation duration were independent risk factors for developing PBI in children under two years during CoA repair. Unstable hemodynamics should be avoided during CPB. (c) 2023 Elsevier Inc. All rights reserved."

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