Pediatric Cardiac Intensive Care, Medanta - The Medicity, Gurgaon, Haryana, 122001, India.
CTVS, Medanta - The Medicity, Gurgaon, Haryana, 122001, India.
Pediatr Cardiol. 2022 Dec;43(8):1770-1783. doi: 10.1007/s00246-022-02914-z. Epub 2022 May 15.
Acute kidney injury (AKI) in children with Transposition of Great arteries (TGA) undergoing Arterial Switch operation (ASO) is an important complication in the post-operative period associated with worse outcomes. AKI in children post open cardiac surgery has been well studied, with lesser data in literature pertaining to TGA and its sub-types specifically. This was a prospective, observational study enrolling infants with TGA undergoing ASO at a single center over a span of a decade from January 2010 to December 2020. The infants were followed during the duration of ICU and hospital stay, with documentation of baseline and intraoperative parameters as well as post-operative course. Out of 145 infants enrolled in the study, 83.1% developed AKI with majority (83.9%) having stage 1 AKI. Higher odds of AKI were seen in infants requiring Norepinephrine [odds ratio - 16.76 (95% CI 2.19-128.2), p < 0.001] and those who developed gram-negative infections [2.81 (1.04-7.56), p - 0.036]. Infants with AKI had significantly higher vasoactive-inotropic support at day 1 than those without AKI [16 (12.5-21.50 vs 13 (10.25-15.75), p - 0.014]. Seventeen infants in the AKI group (14%) died as opposed to none in the non-AKI group (p = 0.076). Median hours of ventilator support required were significantly higher in those with AKI than those who did not develop AKI (48 vs 45.5 p = 0.015). The infants with ASO + ASD + PDA (53% of neonates who died) were younger, had less weight at admission, more gram-negative sepsis and need for dopamine, as compared to ASO + VSD + ASD (23.5% of mortality) and ASO + ASD + VSD + aortic arch repair (23.5% of mortality). AKI in infants with TGA undergoing ASO is common and associated with poorer outcomes. In this subpopulation, AKI development is associated most commonly with hemodynamic instability and infections. This is the first study, looking at outcomes of TGA depending on the sub-types of ASO surgeries done in the infants [ASO with ASD + PDA or ASD + VSD or ASD + VSD + Arch Repair].
儿童大动脉转位（TGA）患者在接受大动脉调转术（ASO）后发生急性肾损伤（AKI）是术后的一个重要并发症，与不良预后相关。儿童心脏手术后 AKI 已有较多研究，但 TGA 及其亚型的相关数据较少。这是一项前瞻性观察研究，纳入了 2010 年 1 月至 2020 年 12 月在一家中心接受 ASO 的 TGA 婴儿。这些婴儿在 ICU 和住院期间接受了随访，记录了基线和术中参数以及术后过程。在纳入研究的 145 名婴儿中，83.1%发生 AKI，其中大多数（83.9%）为 1 期 AKI。需要去甲肾上腺素的婴儿发生 AKI 的几率更高[比值比-16.76（95%CI 2.19-128.2），p<0.001]，发生革兰氏阴性感染的婴儿发生 AKI 的几率更高[2.81（1.04-7.56），p=0.036]。与无 AKI 的婴儿相比，AKI 婴儿在第 1 天的血管活性-正性肌力支持明显更高[16（12.5-21.50 比 13（10.25-15.75），p=0.014]。AKI 组有 17 名婴儿（14%）死亡，而非 AKI 组无死亡（p=0.076）。与未发生 AKI 的婴儿相比，发生 AKI 的婴儿需要呼吸机支持的中位时间更长（48 比 45.5，p=0.015）。与 ASO+VSD+ASD（23.5%死亡）和 ASO+ASD+VSD+主动脉弓修复（23.5%死亡）相比，ASO+ASD+PDA（53%死亡的新生儿）的婴儿更年轻，入院时体重更轻，更易发生革兰氏阴性败血症，需要多巴胺。AKI 在接受 ASO 的 TGA 婴儿中很常见，与较差的预后相关。在这个亚群中，AKI 的发展最常见于血流动力学不稳定和感染。这是第一项研究，观察了 TGA 根据婴儿接受的 ASO 手术的亚型的结果[ASO 伴 ASD+PDA 或 ASD+VSD 或 ASD+VSD+弓修复]。
