Abstract 17998: Continuous Warm Perfusion Reduces Renal Injury During Norwood Operation
Objectives: Perfusion approaches for Norwood include hypothermic circulatory arrest and selective cerebral perfusion. Both techniques result in cold renal ischemia (CRI). Canulation of both the innominate artery and the descending aorta allows maintenance of continuous warm perfusion (CWP) to the kidney and the entire body during arch reconstruction. Renal dysfunction often complicates recovery after complex neonatal cardiac surgery. This review was undertaken to assess the effect of perfusion technique, CRI or CWP, on postoperative renal function.
Methods: Records of 46 consecutive neonates undergoing Norwood since 2004 were reviewed. The Acute Dialysis Quality Initiative Group RIFLE criteria for renal injury and failure were applied.
Results: 17 patients underwent Norwood with CWP, 29 with CRI. Both median bypass time and median crossclamp time were significantly shorter in CWP than CRI (100 v. 189 min, p = 0.005 and 26 v. 68 min, p < 0.001). Creatinine change from baseline was significantly less in CWP than CRI at 24 and 48 hours (1.19 +/- 0.24 v. 1.58 +/- 0.61, p = 0.02; and 1.58 +/- 0.60 v. 1.16 +/- 0.28, p = 0.01)(see Chart). 1 of 17 CWP patients had renal injury by urine output criteria at 24 hours, compared to 7 of 29 CRI patients (p=0.01). 0 of 17 CWP had renal injury by creatinine change criteria, and 2 of 17 had risk of renal dysfunction, versus 6 of 29 and 12 of 29 CRI respectively (p = 0.006 and p = 0.003). Median fluid balance at 24 hours was +121 ml. for CWP vs. +252 ml for CRI. Renal dysfunction eventually resolved in all patients.
Conclusions: Patients undergoing Norwood with continuous warm perfusion of the entire body had less transient renal injury. This was reflected in less early positive fluid balance. Early postoperative renal dysfunction can be avoided through this alternative perfusion technique.
- © 2011 by American Heart Association, Inc.