Congenital heart disease
Postoperative electroencephalographic seizures are associated with deficits in executive function and social behaviors at 4 years of age following cardiac surgery in infancy

Read at the 92nd Annual Meeting of The American Association for Thoracic Surgery, San Francisco, California, April 28-May 2, 2012.
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Objective

The occurrence of an electroencephalographic (EEG) seizure after surgery for complex congenital heart defects has been associated with worse neurodevelopmental (ND) outcomes. We previously identified postoperative seizures documented by 48-hour EEG monitoring in 11% of 178 neonates and infants. Evaluation at 1 year of age did not identify an adverse effect of an EEG seizure on ND outcomes. The current study was undertaken to determine if testing in the preschool period would identify deficits that become apparent as children develop.

Methods

The ND outcomes assessed at 4 years of age included cognition, language, attention, impulsivity, executive function, behavior problems, academic achievement, and visual and fine motor skills.

Results

Developmental evaluations were performed in 132 (87%) of 151 survivors. For the entire cohort, the Full-Scale IQ was 95.0 ± 18.5. IQ was 95.1 ± 18.7 for patients without a history of seizure and 93.6 ± 16.7 for those with a history of seizure. After covariate adjustment, occurrence of an EEG seizure was associated with worse executive function (P = .037) and impaired social interactions/restricted behavior (P = .05). Seizures were not significantly associated with worse performance for cognition, language, attention, impulsivity, academic achievement, or motor skills (all P > .1).

Conclusions

The occurrence of a postoperative seizure is a biomarker of brain injury. This study confirms that postoperative EEG seizures are associated with worse ND outcomes, characterized by impairments of executive function and a higher prevalence of deficits in social interactions and repetitive/restricted behaviors in preschool survivors of cardiac surgery in infancy. However, EEG seizures were not associated with worse cognitive, language, or motor skills.

Abbreviations and Acronyms

APOE
apolipoprotein E
BCAS
Boston Circulatory Arrest Study
CHD
congenital heart defect
CNS
central nervous system
CPB
cardiopulmonary bypass
DHCA
deep hypothermic circulatory arrest
EEG
electroencephalographic
HLHS
hypoplastic left heart syndrome
ND
neurodevelopmental
PDP
pervasive developmental problem
TGA
transposition of the great arteries

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Supported by a grant from the Fannie E. Rippel Foundation, an American Heart Association National Grant-in-Aid 9950480N, and grant HL071834 from the National Institutes of Health.

Disclosures: Authors have nothing to disclose with regard to commercial support.