Stroke Risk Remains a Challenge for Neonatal Cardiac Surgery
Research By: Muhammad Faateh, MBBS | Awais Ashfaq, MD
Post Date: October 15, 2024 | Publish Date: October 2024
After reviewing outcomes of more than 14,000 neonates who received cardiac surgery requiring cardiopulmonary bypass, a team of researchers with the Heart Institute at Cincinnati Children’s reports that more effort is needed to reduce stroke risks.
The study, published in October 2024 in The Annals of Thoracic Surgery, was led by first author Muhammad Faateh, MBBS, and corresponding author Awais Ashfaq, MD. Findings were based on case data from 2004 through 2022 collected from more than 40 hospitals participating in the Pediatric Health Information System (PHIS).
“The most alarming finding from this study is the substantially high mortality in stroke patients, with one-third of stroke patients dying within the index admission,” Ashfaq says.
The researchers found that a perioperative stroke occurred in 800 of the 14,228 neonates studied (5.6%). The stroke subtypes were ischemic/embolic (29.0%), intraventricular hemorrhage (IVH) grade III or IV (11.0%), non-IVH hemorrhagic (52.8%), and mixed (7.3%).
Those born prematurely, diagnosed with hypoplastic left heart syndrome (HLHS), or requiring ECMO, were disproportionately affected by stroke. Those suffering stroke had higher mortality (33.1% vs 8.9%), longer lengths of stay (41 vs 24 days), and higher hospitalization costs ($354,521 vs $180,489). Stroke survivors also experienced higher incidence of hydrocephalus, cerebral palsy and autism spectrum disorder.
No particular modifiable factors to prevent strokes emerged in the study, which prompted the authors to call for further analysis to identify ways to improve rescue after stroke and to find interventions that may improve long-term outcomes.
“Further research should also be directed toward exploring the role of grade I and II IVH in CHD patients, although perceived as conditions with relatively low risks, this study reveals their association with increased mortality,” the study concludes.
About the study
Cincinnati Children’s co-authors also included Kevin Kulshrestha, MD, MBE, Hosam Ahmed, MD, PhD, David Lehenbauer, MD, Michael Carlisle, MD, Michael Gaies, MD, MPH, and David L.S. Morales, MD.
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| Original title: | The Burden of Stroke in Neonates Undergoing Congenital Heart Surgery: A Large Multicenter Analysis |
| Published in: | The Annals of Thoracic Surgery |
| Publish date: | October 2024 |
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The Research Horizons blog features news and insights about the latest discoveries and innovations developed by the scientists of Cincinnati Children's. This blog does not provide medical advice, diagnosis, or treatment. Email researchnews@cchmc.org with questions or ideas.
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