Abstract 19626: Cardio-renal Syndrome in Single Ventricle Patients
Introduction: Cardio-renal syndrome (CRS) in single ventricle patients undergoing stage I or II palliation has not been described. CRS in other high-risk pediatric populations has been associated with greater risk of morbidity and mortality. We aim to describe CRS in single ventricle patients undergoing stage I or II palliation and their associations with clinical outcomes.
Methods: Data was collected from the Pediatric Heart Network (PHN) Infant with Single Ventricle trial. Demographics, survival, and data pertaining to stage I and II palliations were obtained. CRS was determined for each patient based on the estimated creatinine clearance (eCCL) as follows; age 0-days to 12-months eCCL < 40 ml/min/1.73m2 and > 12-months eCCL < 90 ml/min/1.73m2. Descriptive statistics and univariate analyses using the student t-test, Mann-Whitney U, chi-square test or Fisher’s exact test were performed to determine the association between CRS and clinical outcomes as well as mortality, respectively.
Results: Two hundred twenty-nine patients, with median age 6-days [4-7], underwent stage I palliation during the study period, of which 86 (38%) had CRS after their palliation. The most common diagnosis was hypoplastic left heart syndrome (HLHS) with 144 patients (63%) with 169 patients (74%) undergoing a Norwood procedure with a modified Blalock-Taussig (MBT) or Sano shunt. Of the 229 patients, 167 (73%), with median age 151-days [123-176], underwent stage II palliation during the study period, of which 60 (48%) had CRS after their palliation. Of the 60-patients, 25 (42%) also had CRS after their stage I palliation. Stage I palliation patients with CRS had significantly lower baseline eCCL as compared to patients with no CRS (36 vs. 56, p < 0.001), as well as significantly longer ICU and hospital length of stays (14-days vs. 11-days, p < 0.001 and 29-days vs. 11-days, p < 0.001). Twenty patients (9%) died prior to stage II palliation; of the 20 patients, 14 patients (70%) had CRS. CRS was significantly associated with mortality prior to stage II palliation (odds ratio 2.6; 95% CI 1.03, 6.7; p = 0.03).
Conclusion: CRS in single ventricle patients is common and associated with lower pre-operative eCCL, longer lengths of ICU and hospital stay, and mortality prior to stage II palliation.
Author Disclosures: S.I. Aydin: None. K. Glotzbach: None. A. Skversky: None. D. Hsu: None.
- © 2015 by American Heart Association, Inc.