Acute kidney injury after arterial switch operation: incidence, risk factors, clinical impact – a retrospective single-center study

Abstract

Background

This retrospective study aimed to determine the incidence, risk factors, and outcomes of acute kidney injury (AKI) in neonates following the arterial switch operation (ASO) for transposition of great arteries (TGA).

Methods

Retrospective review of medical data of children who underwent ASO in 2019–2020 in the Ukrainian Children’s Cardiac Center.

Results

76 consecutive neonatal patients were included, 48 developed AKI after ASO (51.7%), and 24 – had severe AKI (25.8%). Severe AKI development was associated with longer cross-clamp time: 82 (61–127) versus 73.5 (53–136) in the non-severe AKI group (p = 0.02). 76 min of cross-clamp time were defined as a threshold value for increased severe AKI risk, OR 4.4 (95% CI: 1.5 – 13, p = 0.01). Higher lactate levels during cardiopulmonary bypass (CPB) increased severe AKI development risk, OR 1.5 (95% CI: 1.0 − 2.0, p = 0.03). Children with severe AKI had prolonged mechanical ventilation, longer time to negative fluid balance, and higher postoperative day 3 (POD3) Inotropic Score (IS). Only one patient required peritoneal dialysis.

Conclusions

In our study, 51.7% of patients developed AKI after ASO, 25.8%–severe AKI. Prolonged cross-clamp time and higher lactate levels during cardiopulmonary bypass increased the risk for severe AKI development. The development of AKI was associated with prolonged mechanical ventilation, longer time to negative fluid balance, higher POD 3 Inotropic Score.

Keywords:

• Arterial switch operation
• acute kidney injury
• neonates
• pediatric cardiac surgery

Acknowledgements

None.

Author contributions

Anton Puzanov – design, data collection, formal and statistical analysis, writing, correspondence.

Vadym Tkachuk – design, review, and editing.

Andriy Maksymenko – general supervision, review, and editing.

Consent for publication

Not applicable.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This research received no specific grant from any funding agency, commercial, or not-for-profit sectors.