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Acute kidney injury following first-stage palliation in hypoplastic left heart syndrome: hybrid versus Norwood palliation

Published online by Cambridge University Press:  11 September 2017

Richard U. Garcia Open the ORCID record for Richard U. Garcia [Opens in a new window] ,
Girija Natarajan ,
Henry L. Walters III ,
Ralph E. Delius  and
Sanjeev Aggarwal
Richard U. Garcia*
Affiliation:
Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
Girija Natarajan
Affiliation:
Division of Neonatology, Carman and Ann Adams Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
Henry L. Walters III
Affiliation:
Division of Cardio-Thoracic Surgery, Carman and Ann Adams Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
Ralph E. Delius
Affiliation:
Division of Cardio-Thoracic Surgery, Carman and Ann Adams Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
Sanjeev Aggarwal
Affiliation:
Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
*
Correspondence to: R. Garcia, MD, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States of America. Tel: +1 786 262 3068; Fax: +3139667277; E-mail: rugsal25@gmail.com
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Abstract

Objective

The aim of this study was to evaluate the prevalence of acute kidney injury after first-stage surgical palliation in patients with a single ventricle and to explore associated risk factors and outcomes.

Design and patients

This single-centre retrospective study included neonates who underwent either Norwood or Hybrid procedure from 2008 to 2015 for a single ventricle. Postoperative acute kidney injury was defined using the paediatric risk, injury, failure, loss, end-stage renal disease (pRIFLE), criteria within 72 hours of the procedure.

Main results

Our cohort (n=48) underwent surgical palliation at a mean (SD) age of 12 (11) days. Postoperative acute kidney injury was diagnosed in 14 (29%) patients. The prevalence of acute kidney injury in the Hybrid group was 16% and 53% in the Norwood group. Infants who developed acute kidney injury underwent surgery at younger ages [6 (5–10) versus 10 (8–16) days, p=0.016], and had a higher peak lactate level in the initial 24 hours [5.9 (4.2–9.1) versus 3.4 (2.4–6.7), p=0.007]. Norwood procedure was significantly associated with acute kidney injury [odds ratio 11.7 (95% confidence interval 1.3–101.9), p=0.03]. ICU stay [38 (21–84) versus 16 (6–45) days, p=0.038] and time to extubation [204 (120–606) versus 72 (26–234) hours, p=0.014] were longer in those with acute kidney injury. The two patients who developed early postoperative renal failure as per pRIFLE died before discharge from associated comorbidities.

Conclusions

Acute kidney injury occurs in a third of the patients with single ventricle after surgical palliation but is mostly transient. Norwood, compared with Hybrid procedure, is a risk factor for postoperative acute kidney injury, which, in turn, is associated with longer ICU stay and time to extubation.

Keywords

Acute kidney injuryhybrid procedurehypoplastic left heart syndromepostoperative outcomesCHD
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 2 , February 2018 , pp. 261 - 268
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Copyright
© Cambridge University Press 2017 

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