Newborn Aortic Arch Reconstruction With Descending Aortic Cannulation Improves Postoperative Renal Function

Hammel, James M.; Deptula, Joseph; Karamlou, Tara; Wedemeyer, Elesa W; Abdullah, Ibrahim; Duncan, Kim

doi:10.1016/j.athoracsur.2013.06.033

Cited by 53 publications

(45 citation statements)

References 10 publications

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“…This hypothesis is further supported by Hammel et al who found that postoperative renal function improved with descending aorta cannulation. 20 Although gentamicin-associated AKI has been reported in adults, preoperative aminoglycoside exposure, to our knowledge, has not been reported as a risk factor for neonatal AKI. 21 Preoperative aminoglycoside exposure was a variable that we observed in a large number of our neonates undergoing surgery for congenital heart disease.…”

Section: Discussionmentioning

confidence: 97%

Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease

Piggott

Soni

DeCampli

et al. 2015

World J Pediatr Congenit Heart Surg

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Section: Discussionmentioning

confidence: 97%

Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease

Piggott

Soni

DeCampli

et al. 2015

World J Pediatr Congenit Heart Surg

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“…Postoperative acute kidney injury (AKI) in pediatric patients is a serious complication associated with adverse outcomes including prolonged mechanical ventilation, prolonged hospital stay, and high morbidity and mortality [1–7]. Previous studies have reported that younger age [1, 3, 4, 7], prematurity [4, 6], longer cardiopulmonary bypass (CPB) time [2–4, 6, 7], a high Risk Adjusted Classification of Congenital Heart Surgery (RACHS-1) score [1, 7], longer vasopressor use [3] and selective cerebral perfusion [8, 9] are associated with CS-AKI in infants and children. Recently, several plasma and urine biomarkers reflecting renal injury have been investigated to facilitate early diagnosis [10–12].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Acute Kidney Injury after Congenital Cardiac Surgery in Infants and Children: A Retrospective Observational Study

et al. 2016

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Acute kidney injury (AKI) after pediatric cardiac surgery is associated with high morbidity and mortality. Modifiable risk factors for postoperative AKI including perioperative anesthesia-related parameters were assessed. The authors conducted a single-center, retrospective cohort study of 220 patients (aged 10 days to 19 years) who underwent congenital cardiac surgery between January and December 2012. The incidence of AKI within 7 days postoperatively was determined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Ninety-two patients (41.8%) developed AKI and 18 (8.2%) required renal replacement therapy within the first postoperative week. Among patients who developed AKI, 57 patients (25.9%) were KDIGO stage 1, 27 patients (12.3%) were KDIGO stage 2, and eight patients (3.6%) were KDIGO stage 3. RACHS-1 (Risk-Adjusted classification for Congenital Heart Surgery) category, perioperative transfusion and fluid administration as well as fluid overload were compared between patients with and without AKI. Multivariable logistic regression analyses determined the risk factors for AKI. AKI was associated with longer hospital stay or ICU stay, and frequent sternal wound infections. Younger age (<12 months) [odds ratio (OR), 4.01; 95% confidence interval (CI), 1.77–9.06], longer cardiopulmonary bypass (CPB) time (OR, 2.45; 95% CI, 1.24–4.84), and low preoperative hemoglobin (OR, 2.40; 95% CI, 1.07–5.40) were independent risk factors for AKI. Fluid overload was not a significant predictor for AKI. When a variable of hemoglobin concentration increase (>3 g/dl) from preoperative level on POD1 was entered into the multivariable analysis, it was independently associated with postoperative AKI (OR, 6.51; 95% CI, 2.23–19.03 compared with no increase). This association was significant after adjustment with patient demographics, medication history and RACHS-1 category (hemoglobin increase >3g/dl vs. no increase: adjusted OR, 6.94; 95% CI, 2.33–20.69), regardless of different age groups and cyanotic or non-cyanotic heart disease. Prospective trials are required to evaluate whether correction of preoperative anemia and prevention of hemoconcentration may ameliorate postoperative AKI in patients who underwent congenital cardiac surgery.

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“…Finally, in order to minimize the need for deep hypothermia, surgeons are experimenting with moderately hypothermic splanchnic perfusion during reconstruction of the aortic arch. Only a renal protective effect has been reported with this technique to date; this technique has not been widely adopted.…”

Section: Hypothermiamentioning

confidence: 99%

Recent achievements and future developments in neonatal cardiopulmonary bypass

Bojan

2019

Pediatric Anesthesia

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Summary A primary goal of improving neonatal cardiopulmonary bypass has been making the circuit smaller and reduce the blood contacting surfaces. As bypass circuit size has decreased, bloodless surgery has become possible even in neonates. Since transfusion guidelines are difficult to construct based on existing literature, these technical advances should be taken advantage of in conjunction with an individualized transfusion scheme, based on monitoring of oxygen availability to the tissues. For the majority of neonatal heart operations, several centers have shifted toward normothermic bypass even for complex neonatal surgeries, in order to avoid the adverse effects of hypothermia. Deep hypothermic circulatory arrest is no longer a necessity but an option, and selective antegrade cerebral perfusion has become common practice; however, technical uncertainties with regard to this technique have to be addressed, based on reliable neurologic monitoring. Maintenance of patient‐specific heparin concentrations during bypass is another key goal, since neonates have lower baseline antithrombin concentrations and, therefore, a higher risk for inadequate thrombin inhibition and postoperative bleeding. Due to the immaturity of their hemostatic system, the standard coagulation tests alone are inappropriate to guide hemostatic therapy in neonates. The use of indirect heparin concentration assays and global viscoelastic assays in the operating room is likely to represent the optimal strategy, and requires validation in neonates. Monitoring of global and regional indexes of oxygen availability and consumption on bypass have become possible; however, their use in neonates still has outstanding technical issues which should be addressed and hence needs further validation. Due to the immaturity of the neonatal myocardium, single‐shot cold cardioplegia solutions are thought to confer the best myocardial protection; their superiority when compared to more conventional modalities, however, remains to be demonstrated.

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Newborn Aortic Arch Reconstruction With Descending Aortic Cannulation Improves Postoperative Renal Function

Cited by 53 publications

References 10 publications

Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease

Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease

Risk Factors for Acute Kidney Injury after Congenital Cardiac Surgery in Infants and Children: A Retrospective Observational Study

Recent achievements and future developments in neonatal cardiopulmonary bypass

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