High Risk Of Mortality In Congenital Heart Disease Patients Who Suffer Strokes

Introduction: Congenital heart disease (CHD) patients have many risk factors for stroke. Our goal was to describe CHD patients who suffered strokes and determine factors associated with in-hospital mortality. Methods: Patients with acquired or CHD who suffered a stroke (radiologic evidence of arterial/venous infarct; subdural, subarachnoid, parenchymal or epidural hemorrhage) from 1/2010-5/2014 at our hospital were identified. Patient charts were retrospectively reviewed. Results: Seventy-five stroke patients were identified. Median age at diagnosis was 5.7 months (IQR 0.6, 33.2), and 26 (35%) were neonates. Twenty-six patients (35%) had single ventricle CHD, and 9 (12%) had Fontan circulations. Seven patients (9%) presented with neurologic symptoms at home. The remainder developed neurologic findings after being hospitalized for a median duration of 9.5 days (IQR 4.0, 21.8). Thirty-four patients (45%) presented with clinically evident neurologic deficits (e.g. weakness, seizures). Forty-seven patients (63%) had arterial infarcts, and 14 (19%) had parenchymal hemorrhages. At diagnosis, 49 patients (65%) were on inotropes, 48 (64%) were intubated, and 18 (24%) were on ECMO. Twenty-seven patients (36%) had CPR within 30 days of diagnosis. Twenty-four patients (32%) had ≥3 cardiac procedures (surgical or catheter based) during their hospitalization before stroke diagnosis with a median duration of 3 days (IQR 1, 9) between their last procedure and diagnosis. Forty-eight patients (64%) survived to hospital discharge. Survivors had a median total hospital length of stay of 1.1 months (IQR 0.5, 2.7). Factors associated with in-hospital mortality were: inotropes (p<0.01), intubation (p<0.01), and ECMO (p=0.03) at time of stroke diagnosis; and ≥3 cardiac procedures before stroke diagnosis (p=0.02). Recent CPR (p=0.06) and stroke type (p=0.09) were not associated with in-hospital mortality. Of 37 surviving patients with neurologic follow-up, 21 (57%) had chronic neurologic deficits due to their strokes (median follow-up: 6.0 months, IQR 2.5-22.8). Conclusions: A majority of CHD stroke patients present while hospitalized and without focal neurologic findings. In-hospital mortality is high and associated with severity of illness.