Impact of Different Cardiopulmonary Bypass Strategies on Renal Injury After Pediatric Heart Surgery

Ramakrishnan, Karthik; Spentzas, Thomas; Kumar, Tarun; Allen, Jerry; Staffa, Steven J.; Zurakowski, David; Bigelow, William; Gopal, Srirupa Hari; Boston, Umar S.; Jonas, Richard A.; Knott‐Craig, Christopher J.

doi:10.1016/j.athoracsur.2020.05.056

Cited by 16 publications

(8 citation statements)

References 19 publications

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“…Results may therefore be considered hypothesis-generating and deserve further study using average value or lowest of PpO2 as independent variable. It is well known that different CPB strategies including prime constitutes and flow rates may have different effects on inflammatory response and organ functions [24]. In this study, our CPB strategies had little changes during the study period, leading to reducing the impact of prime constitutes and flow rates on the endpoint event.…”

Section: Discussionmentioning

confidence: 85%

Relation or Influence of RVOTO in the Inflammatory Response to Reoxygenation in Patients with Tetralogy of Fallot

Liu¹,

Ma²,

Li³

et al. 2021

Congenital Heart Disease

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Background: This study evaluated differential inflammatory response to cardiopulmonary bypass reoxygenation in tetralogy of Fallot repair. Methods: We performed a retrospective study at a cardiovascular center from 2012 to 2018, including 500 patients aged 1 week-18 years who received complete repair of tetralogy of Fallot. Patients were grouped according to tertiles of preoperative RVOT gradient on echocardiography into mild, moderate, and severe stenosis. We measured the highest perfusate oxygenation (PpO2) during aortic occlusion as independent variable. Primary outcome was systemic inflammatory response syndrome (SIRS) within 7 days postoperatively or the time of death or discharge. Results: Overall, rate of SIRS was 24.2% without significant differences among three groups (P > 0.05). Older age, male, and smaller indexed left ventricular end-diastolic volume is independent risk factor of SIRS. There were significant interactions between RVOT stenosis and PpO2 on SIRS (P interaction = 0.011): higher PpO2 was associated with a greater SIRS risk among combined moderate and severe stenotic children (OR 1.463 95%CI [1.080, 1.981] per-SD increase, P = 0.014) but not among mild stenotic children (OR 0.900 [0.608, 1.333] per-SD increase; P = 0.600), independent of covariates. Conclusion: The association of PpO2 with SIRS was modified by RVOT obstruction severity in tetralogy of Fallot repair. (Clinical Trials gov: NCT03568357)

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Section: Discussionmentioning

confidence: 85%

Relation or Influence of RVOTO in the Inflammatory Response to Reoxygenation in Patients with Tetralogy of Fallot

Liu¹,

Ma²,

Li³

et al. 2021

Congenital Heart Disease

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“…With this improved survival, more attention has been focused on important perioperative complications including acute kidney injury (AKI) and neurological events. 5–7,14,15 For the past 16 years, we have held the view that since the normal hematocrit of the infant is around 40% and the normal cardiac output is > 3.2 L/min/m 2 , we should mimic these parameters as best we can to effect adequate oxygen delivery (cardiac output times hematocrit) during cardiac surgery, and especially for the neonate and infant who are at highest risk. In 2013, we formalized these aspirations into a “novel” bypass strategy as presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…This strategy was associated with significantly improved renal function in our experience 14 and validated in a recent prospective 2-institutional study in neonates and infants. 15 With this background we hypothesized that our bypass strategy could potentially translate into a lower incidence of early acute neurological injury in the most vulnerable subset of patients.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Acute Neurological Events in Neonates and Infants Undergoing Cardiac Surgery Using a High-Hematocrit/ High-Flow Bypass Strategy

Chakraborty

Ramakrishnan

Buyukgoz

et al. 2023

World J Pediatr Congenit Heart Surg

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Background: The incidence of new acute neurological injury occurring in neonates and infants during cardiac surgery utilizing cardiopulmonary bypass is reportedly 3% to 5%. In 2013, we adopted a high flow rate, and high hematocrit bypass strategy, and sought to assess the incidence of early neurological injuries associated with this strategy. Methods: Neonates and infants undergoing cardiopulmonary bypass between January 2013 and December 2019 (n = 714) comprise the study. Adverse neurological events (ANEs) were defined as any abnormality of pupils, delayed awakening, seizures, focal neurological deficits, concerns prompting neurological consultation, or any abnormality on neurological imaging in the postoperative period. Our bypass strategy included a high flow rate (150-200 mL/kg/min), without reduction of flow rates during cooling and maintaining a target hematocrit on bypass > 32% with a terminal hematocrit of > 42%. Results: Median weight at the time of the procedure was 4.6 kg (IQR 3.6-6.1 kg) with the smallest patient weighing 1.36 kg. There were 46 premature patients (6.4%). There were 149 patients (20.9%) patients who underwent deep hypothermic circulatory arrest with a median time of 26 min (IQR 21-41 min). Hospital mortality was 3.5% (24/714, 95% CI: 2.28-5.13). The incidence of neurological events as defined above was 0.84% (6/714, 95% CI: 0.31-1.82). Neurological imaging identified ischemic injury in 4 patients and intraventricular hemorrhage in 2. Conclusions: High flow/high hematocrit bypass strategy was associated with a low incidence of ANE in this vulnerable population.

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“…In addition to the EuroSCORE II, massive intraoperative bleeding was another risk factor for mortality in patients with AKI-CRRT. Bleeding is a determinant of excessive haemodilution during cardiac surgery, and the lowest haematocrit is widely recognized as related to AKI [ 22 – 25 ]. The main explanation for this association is that first, the increase in renal tubular transport leads to an increase in kidney energy requirements.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for mortality in patients undergoing continuous renal replacement therapy after cardiac surgery

Liu

Zhang

Yue

et al. 2021

BMC Cardiovasc Disord

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Background To investigate the risk factors for mortality in patients with acute kidney injury requiring continuous renal replacement therapy (AKI-CRRT) after cardiac surgery. Methods In this retrospective study, patients who underwent AKI-CRRT after cardiac surgery in our centre from January 2015 to January 2020 were included. Univariable and multivariable analyses were performed to identify the risk factors for in-hospital mortality. Results A total of 412 patients were included in our study. Of these, 174 died after AKI-CRRT, and the remaining 238 were included in the survival control group. Multivariable logistic regression analysis revealed that EuroSCORE > 7 (odds ratio [OR], 3.72; 95% confidence interval [CI], 1.92–7.24; p < 0.01), intraoperative bleeding > 1 L (OR, 2.14; 95% CI, 1.19–3.86; p = 0.01) and mechanical ventilation time > 70 h (OR, 5.03; 95% CI, 2.40–10.54; p < 0.01) were independent risk factors for in-hospital mortality in patients who had undergone AKI-CRRT. Our study also found that the use of furosemide after surgery was a protective factor for such patients (odds ratio, 0.48; 95% confidence interval, 0.25–0.92; p = 0.03). Conclusions In summary, the mortality of patients with AKI-CRRT after cardiac surgery remains high. The EuroSCORE, intraoperative bleeding and mechanical ventilation time were independent risk factors for in-hospital mortality. Continuous application of furosemide may be associated with a better outcome.

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Impact of Different Cardiopulmonary Bypass Strategies on Renal Injury After Pediatric Heart Surgery

Cited by 16 publications

References 19 publications

Relation or Influence of RVOTO in the Inflammatory Response to Reoxygenation in Patients with Tetralogy of Fallot

Relation or Influence of RVOTO in the Inflammatory Response to Reoxygenation in Patients with Tetralogy of Fallot

Incidence of Acute Neurological Events in Neonates and Infants Undergoing Cardiac Surgery Using a High-Hematocrit/ High-Flow Bypass Strategy

Risk factors for mortality in patients undergoing continuous renal replacement therapy after cardiac surgery

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