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Risk Factors for Peri-Procedural Arterial Ischaemic Stroke in Children with Cardiac Disease

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Abstract

Improved survival of children with congenital heart disease has led to increasing focus on neurodevelopmental outcome, as close to half of the infants undergoing cardiac surgery are affected by neurodevelopmental disability. Stroke is particularly important as it frequently results in permanent neurologic sequelae. The aim of this study was to investigate risk factors for peri-procedural arterial ischaemic stroke (AIS) in children with cardiac disease. A retrospective case–control analysis of children aged <18 years with radiologically confirmed AIS following a cardiac procedure admitted to the Royal Children’s Hospital Melbourne between 1993 and 2010. Each case was matched with two controls with similar cardiac diagnosis, procedure type, age and date of procedure. Demographics and peri-procedural data were collected from medical records and departmental database. Fifty-two cases were identified. Multivariable analysis identified post-procedural infection (OR 6.1, CI 1.3–27, p = 0.017) and length of ICU stay (OR 4.0, CI 1.4–11, p = 0.009) as risk factors for AIS. Although the study is limited to a single-centre cohort, length of ICU stay and post-procedural infection were identified as risk factors for AIS. These findings demonstrate these factors to be important areas to focus attention for stroke prevention in children with cardiac disease.

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Acknowledgements

All phases of this study were supported by the Brain Foundation Australia. Dr.Asakai is also supported by Nissan Australia. Dr.Cardamone is also supported by Uncle Bob’s Neurology fellowship. The Heart Research Group is supported by RCH 1000, RCH Foundation and Big W. The MCRI is supported by the Victorian Government’s Operational Infrastructure Support Program.

Funding

This study was supported by the Brain Foundation Australia.

Author information

Authors and Affiliations

  1. Department of Cardiology, Royal Children’s Hospital, Heart Research Group, Murdoch Children’s Research Institute, Parkville, VIC, Australia

    Darren Hutchinson & Michael M. H. Cheung

  2. Department of Neurology, Royal Children’s Hospital, Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia

    Belinda Stojanovski & Mark T. Mackay

  3. The Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, VIC, Australia

    John C. Galati & Dianna Zannino

  4. Department of Mathematics and Statistics, La Trobe University, Melbourne, VIC, Australia

    John C. Galati

  5. Department of Neurology, Sydney Children’s Hospital, Randwick, NSW, Australia

    Michael Cardamone

  6. Department of Pediatrics, University of Tokyo Hospital, Tokyo, Japan

    Hiroko Asakai

  7. Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia

    Belinda Stojanovski, Darren Hutchinson, Michael M. H. Cheung & Mark T. Mackay

Authors
  1. Hiroko Asakai
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  2. Belinda Stojanovski
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  3. John C. Galati
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  4. Dianna Zannino
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  5. Michael Cardamone
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  6. Darren Hutchinson
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  7. Michael M. H. Cheung
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  8. Mark T. Mackay
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Corresponding author

Correspondence to Mark T. Mackay.

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Asakai, H., Stojanovski, B., Galati, J.C. et al. Risk Factors for Peri-Procedural Arterial Ischaemic Stroke in Children with Cardiac Disease. Pediatr Cardiol 38, 1385–1392 (2017). https://doi.org/10.1007/s00246-017-1674-x

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  • DOI: https://doi.org/10.1007/s00246-017-1674-x

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