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Peak Creatinine, Cardiopulmonary Bypass and Mortality After Stage One Single-ventricle Reconstruction

Ann Thorac Surg. 2019 Oct 12. [Epub ahead of print]

It is important to identify therapies which minimise complications associated with prolonged cardiopulmonary bypass duration in high risk populations.

Background

Serum creatinine is the most commonly used marker to diagnose acute kidney injury. Studies exploring creatinine patterns in the single-ventricle population are scarce. We studied serum creatinine up to 5 postoperative days after stage-1 operation and assessed its relationship with outcomes.

Methods

Retrospective analysis of neonates who underwent a first stage single ventricle operation (either a Norwood or a Damus-Kaye-Stansel) between 2005-2017. Peak percentage creatinine change (PPCC) was defined as the difference between the baseline (before operation) and the peak postoperative level (within 5-postoperative days), expressed as a percentage of baseline level.

Results

Among 187 neonates included, the median PPCC was 38.7 %( interquartile range, 14.1 to 73.1) and mortality in hospital was 17% (31 of 187). In a controlled analysis, for every 10-minute increase in cardiopulmonary bypass duration (CPB), the PPCC increased by 1.8%( 95% CI 0.7-2.9; P= 0.002). Risk of death in hospital increased log-linearly with PPCC. The adjusted odds ratio (95% CI) for death in hospital associated with a 50%, 100% and 200% increase in peak percentage creatinine change were 1.85(1.23, 2.78), 3.41(1.15, 7.72) and 11.66(2.28, 59.63) respectively. Death in hospital was also associated with CPB duration [adjusted odds ratio 1.13 per 10-minute increase, 95% CI (1.05-1.22), p=0.001]

Conclusions

Increase in CPB duration has a strong linear association with increase in PPCC following stage one single-ventricle reconstruction. Increase in PPCC and CPB duration has a strong linear association with hospital mortality. It is important to identify therapies which minimise complications associated with prolonged cardiopulmonary bypass duration in high risk populations.

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