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Acute kidney injury in hypoplastic left heart syndrome patients following the comprehensive stage two palliation

Published online by Cambridge University Press:  11 August 2023

Tyler W. Cunningham Open the ORCID record for Tyler W. Cunningham [Opens in a new window] ,
Shasha Bai ,
Catherine D. Krawczeski ,
John D. Spencer ,
Christina Phelps  and
Andrew R. Yates Open the ORCID record for Andrew R. Yates [Opens in a new window]
Tyler W. Cunningham*
Affiliation:
Department of Pediatrics, Section of Cardiology and Critical Care, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, AR, USA
Shasha Bai
Affiliation:
Pediatric Biostatistics, Emory University, Atlanta, GA, USA
Catherine D. Krawczeski
Affiliation:
The Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA
John D. Spencer
Affiliation:
Section of Nephrology, Nationwide Children’s Hospital, Columbus, OH, USA
Christina Phelps
Affiliation:
The Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA
Andrew R. Yates
Affiliation:
The Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA
*
Corresponding author: T. W. Cunningham; Email: twcunningham@uams.edu
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Abstract

Background:

An alternative surgical approach for hypoplastic left heart syndrome is the Hybrid pathway, which delays the risk of acute kidney injury outside of the newborn period. We sought to determine the incidence, and associated morbidity, of acute kidney injury after the comprehensive stage 2 and the cumulative incidence after the first two operations in the Hybrid pathway.

Design:

A single centre, retrospective study was conducted of hypoplastic left heart patients completing the second-stage palliation in the Hybrid pathway from 2009 to 2018. Acute kidney injury was defined utilising Kidney Diseases Improving Global Outcomes criteria. Perioperative and post-operative characteristics were analysed.

Results:

Sixty-one patients were included in the study cohort. The incidence of acute kidney injury was 63.9%, with 36.1% developing severe injury. Cumulatively after the Hybrid Stage 1 and comprehensive stage 2 procedures, 69% developed acute kidney injury with 36% developing severe injury. The presence of post-operative acute kidney injury was not associated with an increase in 30-day mortality (acute kidney injury 7.7% versus none 9.1%; p = > 0.9). There was a significantly longer median duration of intubation among those with acute kidney injury (acute kidney injury 32 (8, 155) hours vs. no injury 9 (0, 94) hours; p = 0.018).

Conclusions:

Acute kidney injury after the comprehensive stage two procedure is common and accounts for most of the kidney injury in the first two operations of the Hybrid pathway. No difference in mortality was detected between those with acute kidney injury and those without, although there may be an increase in morbidity.

Keywords

Hybridhypoplastic left heartsingle ventricleacute kidney injurycomprehensive stage 2
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 3 , March 2024 , pp. 552 - 558
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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