The Journal of Thoracic and Cardiovascular Surgery
Volume 140, Issue 2 , Pages 453-458, August 2010

Acute kidney injury and regional abdominal perfusion during neonatal aortic arch reconstruction

  • Satish K. Rajagopal, MD

      Affiliations

    • Department of Cardiology, Children's Hospital Boston, Boston, Mass
    • Harvard Medical School, Boston, Mass
    • Corresponding Author InformationAddress for reprints: Satish K. Rajagopal, MD, Department of Cardiology, Children's Hospital, Boston, 300 Longwood Ave, Boston, MA 02115.
    • ,
  • Sitaram M. Emani, MD

      Affiliations

    • Department of Cardiac Surgery, Children's Hospital Boston, Boston, Mass
    • Harvard Medical School, Boston, Mass
    • ,
  • Nathalie Roy, MD

      Affiliations

    • Department of Cardiac Surgery, Children's Hospital Boston, Boston, Mass
    • ,
  • Lauren Westgate, RN, CPNP

      Affiliations

    • Department of Cardiology, Children's Hospital Boston, Boston, Mass
    • ,
  • Emile A. Bacha, MD

      Affiliations

    • Department of Cardiac Surgery, Children's Hospital Boston, Boston, Mass
    • Harvard Medical School, Boston, Mass

Received 29 September 2009; received in revised form 19 January 2010; accepted 21 March 2010. published online 06 May 2010.

Objective

Our objective was to determine whether regional visceral perfusion during neonatal aortic arch reconstruction attenuates postoperative acute kidney injury.

Methods

A technique to provide simultaneous perfusion to the brain and viscera during aortic arch reconstruction in neonates was developed and applied (multisite perfusion). The effect of the technique on postoperative renal function was assessed by comparing the incidence of acute kidney injury in neonates undergoing multisite perfusion to a control group of neonates who underwent aortic arch reconstruction with regional cerebral perfusion alone.

Results

Thirteen neonates underwent multisite perfusion during procedures involving reconstruction of the aortic arch. Twenty-four neonates who underwent similar procedures with regional cerebral perfusion alone were selected as controls. The incidence of acute kidney injury in those undergoing multisite perfusion was 8% (n = 1), compared with 50% (n = 12) in the control group (P = .01). The median percentage change in estimated creatinine clearance was 0 (−33 to +60) in the multisite perfusion group, compared with −29 (−50 to +14) in the control group (P < .01). Patients in the multisite perfusion group were less frequently exposed to preoperative nephrotoxins and intraoperative aprotinin and had a higher prevalence of preoperative comorbidity, a shorter duration of regional cerebral perfusion, and a longer length of stay in the intensive care unit.

Conclusions

Acute kidney injury is common after reconstruction of the aortic arch in neonates. By providing direct visceral perfusion during surgery, this simple multisite perfusion technique may ameliorate acute kidney injury in these neonates. Further investigation of this technique is warranted.

CTSNet classification: 20, 21, 41.3

Abbreviations and Acronyms: AKI, acute kidney injury, CPB, cardiopulmonary bypass, eCCL, estimated creatinine clearance, MSP, multisite perfusion, pRIFLE, Pediatric Risk, Injury, Failure, Loss, End Stage classification of acute kidney injury, RCP, regional cerebral perfusion, VSD, ventricular septal defect

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 All work was performed in the Children's Hospital Boston, Boston, Mass.

 Financial support provided by the Bertelson Critical Care Research Fund.

 Disclosures: None.

PII: S0022-5223(10)00329-6

doi:10.1016/j.jtcvs.2010.03.034

The Journal of Thoracic and Cardiovascular Surgery
Volume 140, Issue 2 , Pages 453-458, August 2010

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