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

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

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.