269

Introduction: We wished to evaluate the incidence, risk factors and outcomes associated with post-operative seizures in cardiac surgery patients. Methods: A retrospective review of cardiac surgery patients from 2008–2011 was conducted. We identified patients who experienced post-operative seizures after cardiac surgery requiring cardiopulmonary bypass. Patients with a pre-existing seizure disorder, or on pre-operative seizure medications, were excluded. Results: A total of 3,406 patients underwent cardiac surgery requiring cardiopulmonary bypass during the study period. Forty-two patients (1.2%) had post-operative, generalized tonic-clonic seizures. About half of the patients with clear documentation of timing had only one seizure (47.6%). The average time to seizure onset was 25.44 +/- 51.4 hours. The mortality for patients with post-operative seizures was 7.1%, significantly higher than patients without post-operative seizures (1.7%, p=0.0467). Most patients (95%) underwent CT scan of the head. Seven patients (16.7%) had an acute, embolic cerebrovascular accident (CVA). This is substantially higher than the incidence of stroke among patients who did not have a seizure (1.2%, p=0.0001). There were no in hospital deaths for seizure patients without an acute CVA. The mortality rate for patients with seizure associated with an acute CVA was 42.9% (p=0.005). The type of cardiac surgery did not significantly influence the incidence of seizures, including aortic reconstruction with deep hypothermic circulatory arrest. Severe calcification of the aorta was far more common in the seizure group (30.6% vs. 5.7%, p=0.0001) as was pre-operative hemodialysis (14.6% vs 2.7%, p=0.001). Thirty-six percent of seizure patients were discharged to home and 56.1% were discharged to inpatient rehab or a skilled nursing facility. Conclusions: Seizures are an infrequent occurrence in patients having open heart surgery with cardiopulmonary bypass. The occurrence of a seizure did predict an increase in perioperative mortality, but only in that subset of patients with evidence of an embolic event documented on CT imaging. For those patients having seizures without structural damage, the operative mortality is not increased and patients and their families can expect an otherwise normal postoperative recovery.