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Kim ME, Gist KM, Brandewie K, Zang H, Lehenbauer D, Winlaw DS, Morales DLS, Alten JA, Goldstein SL, Cooper DS. Kinetics of Renin Concentrations in Infants Undergoing Congenital Cardiac Surgery. J Intensive Care Med 2024:8850666241268655. [PMID: 39094610 DOI: 10.1177/08850666241268655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
BACKGROUND Elevated renin has been shown to predict poor response to standard vasoactive therapies and is associated with poor outcomes in adults. Similarly, elevated renin was associated with mortality in children with septic shock. Renin concentration profiles after pediatric cardiac surgery are unknown. The purpose of this study was to characterize renin kinetics after pediatric cardiac surgery. METHODS Single-center retrospective study of infants who underwent cardiac surgery with cardiopulmonary bypass (CPB) utilizing serum samples obtained in the perioperative period to measure plasma renin concentrations (pg/mL). Time points included pre-bypass and 1, 4, and 24 h after initiation of CPB. RESULTS Fifty patients (65% male) with a median age 5 months (interquartile range (IQR) 3.5, 6.5) were included. Renin concentrations peaked 4 h after CPB. There was a significant difference in preoperative and 4 h post-CPB renin concentration (4 h post-CPB vs preoperative: mean difference 100.6, 95% confidence interval (CI) 48.9-152.4, P < .001). Median renin concentration at 24 h after CPB was lower than the preoperative baseline. CONCLUSIONS We describe renin kinetics in infants after CPB. Future studies based on these data can now be performed to evaluate the associations of elevated renin concentrations with adverse outcomes.
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Affiliation(s)
- Michael E Kim
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Katja M Gist
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katie Brandewie
- Department of Critical Care Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Huaiyu Zang
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David Lehenbauer
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David S Winlaw
- Heart Center, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David L S Morales
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jeffrey A Alten
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stuart L Goldstein
- Division of Nephrology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David S Cooper
- Department of Pediatrics, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Borchert E, de la Fuente R, Guzmán AM, González K, Rolle A, Morales K, González R, Jalil R, Lema G. Biomarkers as predictors of renal damage in neonates undergoing cardiac surgery. Perfusion 2020; 36:825-831. [PMID: 33140691 DOI: 10.1177/0267659120968377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acute Kidney Injury is a complication in children with heart disease undergoing cardiac surgery with cardiopulmonary bypass. The aim of this study is to describe the behavior of KIM-1 (Kidney Injury Molecule) and NGAL (Neutrophil Gelatinase Associated Lipocalin) as early predictors of renal damage, comparing them with serum creatinine and creatinine clearance, in neonates undergoing cardiac surgery. METHODS Twenty-one (21) neonates, under 4 kg, with complex congenital heart diseases, RACHS-1 > 3, without preoperative renal failure, were studied. Serum creatinine and creatinine clearance were measured preoperatively and at 24, 48, 72, 96 hours postoperatively. Urinary samples of KIM-1(pg/ml) and NGAL (ng/ml) were collected after induction of anesthesia at 24 and 48 hours post-operatively. RESULTS nRIFLE criteria were used to divide cohorts in "NO AKI" (12 patients) and "AKI" (nine patients). In the AKI group, serum creatinine increased significantly and creatinine clearance decreased significantly at 24, 48, and 72 hours compared with their respective baseline values. There was no difference in KIM-1 and NGAL values between patients who developed AKI and those who did not at any measured time. CONCLUSIONS The deterioration of renal function continues to be one of the most frequent complications in this population. In our study, biomarkers did not show any correlation with the appearance of AKI. It remains to be seen whether this behavior of the biomarkers is linked with the non-consistent release of these types of molecules in immature kidneys. It is likely that a larger panel of biomarkers together with other glomerular filtration rate assessment methods will provide more information about AKI diagnosis.
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Affiliation(s)
- Evelyn Borchert
- Anesthesia Division, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - René de la Fuente
- Anesthesia Division, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Ana María Guzmán
- Clinical Laboratory,Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Katia González
- Anesthesia Division, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Augusto Rolle
- Anesthesia Division, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Karina Morales
- Pediatric Intensive Care, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Rodrigo González
- Cardiovascular Surgery, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Roberto Jalil
- Nephrology. Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Guillermo Lema
- Anesthesia Division, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
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Borchert Billik E, Lema G. AKI - biomarkers - neonatal cardiac surgery. No answer yet. Acta Anaesthesiol Scand 2018; 62:1487. [PMID: 30109705 DOI: 10.1111/aas.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/01/2018] [Accepted: 07/09/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | - Guillermo Lema
- Division of Anesthesiology, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Jo YY, Kim JY, Lee JY, Choi CH, Chang YJ, Kwak HJ. The effect of intraoperative dexmedetomidine on acute kidney injury after pediatric congenital heart surgery: A prospective randomized trial. Medicine (Baltimore) 2017; 96:e7480. [PMID: 28700489 PMCID: PMC5515761 DOI: 10.1097/md.0000000000007480] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Dexmedetomidine has been reported to have a renal protective effect after adult open heart surgery. The authors hypothesized that intraoperative infusion of dexmedetomidine would attenuate the decrease in renal function after pediatric open heart surgery. METHODS Twenty-nine pediatric patients (1-6 years) scheduled for atrial or ventricular septal defect repair were randomly assigned to receive either continuous infusion of normal saline (control group, n = 14) or dexmedetomidine (a bolus dose of 0.5 μg/kg and then an infusion of 0.5 μg/kg/h) (dexmedetomidine group, n = 15) from anesthesia induction to the end of cardiopulmonary bypass. Serum creatinine (Scr) was measured before surgery (T0), 10 minutes after anesthesia induction (T1), 5 minutes after cardiopulmonary bypass weaning (T2), 2 hours after T2 (T3), and after postoperative day 1 (POD1) and postoperative day 2 (POD2) and estimated glomerular filtration rates (eGFRs) were calculated. Renal biomarkers were measured at T1, T2, and T3. Acute kidney injury (AKI) was defined as an absolute increase in Scr of ≥ 0.3 mg/dL or a percent increase in Scr of ≥50%. RESULTS The incidence of AKI during the perioperative period was significantly higher in the control group than in the dexmedetomidine group (64% [9/14] vs 27% [4/15], P = .042). eGFR was significantly lower in the control group than in the dexmedetomidine group at T2 (72.6 ± 15.1 vs 83.9 ± 13.5, P = .044) and T3 (73.4 ± 15.4 vs 86.7 ± 15.9, P = .03). CONCLUSION Intraoperative infusion of dexmedetomidine may reduce the incidence of AKI and suppress post-bypass eGFR decline.
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Affiliation(s)
- Youn Yi Jo
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon
| | - Ji Young Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul
| | - Ji Yeon Lee
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon
| | - Chang Hu Choi
- Department of Cardiovascular Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Young Jin Chang
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon
| | - Hyun Jeong Kwak
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon
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De Cock PAJG, Mulla H, Desmet S, De Somer F, McWhinney BC, Ungerer JPJ, Moerman A, Commeyne S, Vande Walle J, Francois K, Van Hasselt JGC, De Paepe P. Population pharmacokinetics of cefazolin before, during and after cardiopulmonary bypass to optimize dosing regimens for children undergoing cardiac surgery. J Antimicrob Chemother 2016; 72:791-800. [DOI: 10.1093/jac/dkw496] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 10/17/2016] [Indexed: 02/03/2023] Open
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Song Y, Kim DW, Kwak YL, Kim BS, Joo HM, Ju JW, Yoo YC. Urine Output During Cardiopulmonary Bypass Predicts Acute Kidney Injury After Cardiac Surgery: A Single-Center Retrospective Analysis. Medicine (Baltimore) 2016; 95:e3757. [PMID: 27258505 PMCID: PMC4900713 DOI: 10.1097/md.0000000000003757] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Urine output is closely associated with renal function and has been used as a diagnostic criterion for acute kidney injury (AKI). However, urine output during cardiopulmonary bypass (CPB) has never been identified as a predictor of postoperative AKI. Considering altered renal homeostasis during CPB, we made a comprehensible approach to CPB urine output and evaluated its predictability for AKI.Patients undergoing cardiovascular surgery with the use of CPB, between January 2009 and December 2011, were retrospectively reviewed. AKI was defined as an increase in serum creatinine ≥0.3 mg/dL in the first postoperative 48 hours. We extrapolated a possible optimal amount of urine output from the plot of probability of AKI development according to CPB urine output. After separating patients by the predicted optimal value, we performed stepwise logistic regression analyses to find potential predictors of AKI in both subgroups.A total of 696 patients were analyzed. The amount of CPB urine output had a biphasic association with the incidence of AKI using 4 mL/kg/h as a boundary value. In a multivariate logistic regression to find predictors for AKI in entire patients, CPB urine output did not show statistical significance. After separating patients into subgroups with CPB urine output below and over 4 mL/kg/h, it was identified as an independent predictor for AKI with the odds ratio of 0.43 (confidence interval 0.30-0.61) and 1.11 (confidence interval 1.02-1.20), respectively.The amount of urine output during CPB with careful analysis may serve as a simple and feasible method to predict the development of AKI after cardiac surgery at an early time point.
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Affiliation(s)
- Young Song
- From the Department of Anesthesiology and Pain Medicine (YS, YLK, HMJ, JWJ, YCY); Anesthesia and Pain Research Institute (YS, YLK, YCY), Yonsei University College of Medicine, Seoul; Department of Policy Research Affairs (DWK), National Health Insurance Corporation Ilsan Hospital, Goyang; and Division of Nephrology (BSK), Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Heckmann M, d'Uscio CH, de Laffolie J, Neuhaeuser C, Bödeker RH, Thul J, Schranz D, Frey BM. Major cardiac surgery induces an increase in sex steroids in prepubertal children. Steroids 2014; 81:57-63. [PMID: 24252380 DOI: 10.1016/j.steroids.2013.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
While the neuroprotective benefits of estrogen and progesterone in critical illness are well established, the data regarding the effects of androgens are conflicting. Surgical repair of congenital heart disease is associated with significant morbidity and mortality, but there are scant data regarding the postoperative metabolism of sex steroids in this setting. The objective of this prospective observational study was to compare the postoperative sex steroid patterns in pediatric patients undergoing major cardiac surgery (MCS) versus those undergoing less intensive non-cardiac surgery. Urinary excretion rates of estrogen, progesterone, and androgen metabolites (μg/mmol creatinine/m(2) body surface area) were determined in 24-h urine samples before and after surgery using gas chromatography-mass spectrometry in 29 children undergoing scheduled MCS and in 17 control children undergoing conventional non-cardiac surgery. Eight of the MCS patients had Down's syndrome. There were no significant differences in age, weight, or sex between the groups. Seven patients from the MCS group showed multi-organ dysfunction after surgery. Before surgery, the median concentrations of 17β-estradiol, pregnanediol, 5α-dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA) were (control/MCS) 0.1/0.1 (NS), 12.4/11.3 (NS), 4.7/4.4 (NS), and 2.9/1.1 (p=0.02). Postoperatively, the median delta 17β-estradiol, delta pregnanediol, delta DHT, and delta DHEA were (control/MCS) 0.2/6.4 (p=0.0002), -3.2/23.4 (p=0.013), -0.6/3.7 (p=0.0004), and 0.5/4.2 (p=0.004). Postoperative changes did not differ according to sex. We conclude that MCS, but not less intensive non-cardiac surgery, induced a distinct postoperative increase in sex steroid levels. These findings suggest that sex steroids have a role in postoperative metabolism following MCS in prepubertal children.
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Affiliation(s)
- Matthias Heckmann
- Dept. of General Pediatrics & Neonatology, Justus Liebig University, 35385 Giessen, Germany.
| | - Claudia H d'Uscio
- Dept. of Nephrology & Hypertension, University Hospital Bern, Bern, Switzerland
| | - Jan de Laffolie
- Dept. of General Pediatrics & Neonatology, Justus Liebig University, 35385 Giessen, Germany
| | - Christoph Neuhaeuser
- Dept. of General Pediatrics & Neonatology, Justus Liebig University, 35385 Giessen, Germany
| | - Rolf-Hasso Bödeker
- Institute of Medical Statistics, Justus Liebig University, 35385 Giessen, Germany
| | - Josef Thul
- Dept. of Pediatric Cardiology, Justus Liebig University, 35385 Giessen, Germany
| | - Dietmar Schranz
- Dept. of Pediatric Cardiology, Justus Liebig University, 35385 Giessen, Germany
| | - Brigitte M Frey
- Dept. of Nephrology & Hypertension, University Hospital Bern, Bern, Switzerland; Dept. of Clinical Research, University Hospital Bern, Bern, Switzerland
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Urinary glutathione S-transferases in the pathogenesis and diagnostic evaluation of acute kidney injury following cardiac surgery: a critical review. Curr Opin Crit Care 2013; 16:550-5. [PMID: 20930627 DOI: 10.1097/mcc.0b013e32833fdd9a] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW A focused review of the nature, source, physiological role and rapidly expanding evidence for glutathione S-transferase (GST) subtypes π and α as biomarkers of acute kidney injury (AKI) in patients undergoing cardiac surgery. Expanded insights into the site-specific expression of the GSTs in defined parts of the nephron during renal damage are presented, with particular emphasis on the pathogenesis of cardiac surgery and cardiopulmonary bypass (CPB)-associated AKI and the role of GSTs in oxygen radical disposal. RECENT FINDINGS Recent developments have highlighted a potential role of urinary α-GST and π-GST in the diagnostic evaluation of cardiac surgery-associated AKI. Both urinary α-GST and π-GST are detected in the postoperative period. π-GST performed best at predicting AKI severity at the time of the initial diagnosis of AKI. α-GST was able to predict the future development of both stage 1 and stage 3 AKI. SUMMARY The current data from a small number of patients suggest a potential role of urinary GSTs in the clinical diagnostic evaluation of AKI following cardiac surgery. The performance of the GSTs for the early diagnosis of AKI needs to be validated in larger multicentre studies and in other patient populations at increased risk of AKI (e.g. patients with acute transplant rejection, septic patients). Comparison with other emerging AKI biomarkers is required to continue the development of π-GST and α-GST. Finally, additional studies examining the pathophysiological role of the GSTs in minimizing oxygen free radical exposure in the renal tubules during CPB may shed further light into their role as promising biomarkers of cardiac surgery-associated AKI.
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Darcin OT, Zor MH, Sahin V, Kara I, Bekmezci M, Sahsivar O. Effect of iloprost on renal function in patients undergoing coronary artery bypass grafting: a clinical study. Ann Thorac Cardiovasc Surg 2012; 19:12-7. [PMID: 22785552 DOI: 10.5761/atcs.oa.11.01827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Renal dysfunction remains a serious complication of coronary artery bypass grafting (CABG) surgery and is associated with increased mortality and morbidity. To date, a number of different strategies, including new pharmacologic agents, off-pump and cardiopulmonary bypass techniques have been used to avoid it, but none of them proves the excellent result. METHODS Between April 2009 to September 2011, 185 consecutive patients with multivessel coronary artery disease undergoing elective CABG were included the study. Iloprost was given with the onset of rewarming period at a dose of 1.25-2.5 ng/kg/min and it was ended together with the ending of CPB in 94 patients and remaining were in the control group. Creatinine clearance (CCr) and GFR were measured at the time of hospitalisation and on day first and fifth postoperatively. Serum potassium level was determined every 6 hours, during the first 24 hours postoperatively, and every 12 hours for the next 72 hours, and glomerular filtration rate was estimated. RESULTS There was no statistically significant difference in preoperative comorbidity. There were no significant differences in postoperative morbidity or mortality between either of the two groups that completed the study. However, urine output during the operation was significantly higher in the study group. An increase in creatine levels was more common in the control group. Development of a new CCr less than 50 ml/min was also significantly higher in the control group, postoperatively. CONCLUSION Our study demonstrates that prophylactic intravenous iloprost administration after initiation of a rewarming period during CPB in patients undergoing CABG surgery is associated with improved renal function, compared with conventional treatment in well-hydrated patients. It also has a good safety profile and is generally well tolerated.
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Affiliation(s)
- Osman Tansel Darcin
- Konya Education and Research Hospital, Clinic of Cardiovascular Surgery, Konya, Turkey.
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Lema G, Aeschlimann N, Becker P. Normothermia versus hypothermia during pediatric cardiac surgery: no answer as yet. J Thorac Cardiovasc Surg 2012; 143:758; author reply 758-9. [PMID: 22340032 DOI: 10.1016/j.jtcvs.2011.10.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 10/21/2011] [Accepted: 10/31/2011] [Indexed: 10/28/2022]
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Tirilomis T, Friedrich M, Coskun KO, Tempes T, Popov AF, Schmitto JD, Schoendube FA. Cardiopulmonary bypass and its direct effects on neonatal piglet kidney morphology. Artif Organs 2011; 35:1103-5. [PMID: 21973032 DOI: 10.1111/j.1525-1594.2011.01364.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Renal failure after open heart surgery is a serious complication even in the pediatric population. The aim of the present study was to analyze morphological changes after cardiopulmonary bypass (CPB) surgery in a neonatal piglet model. The kidneys of newborn piglets sacrificed 6 h after CPB were examined (CPB; n = 4) regarding tubular dilatation, vacuole formation, leukocytic infiltration, epithelial destruction, and interstitial edema. Thereafter, the findings were compared with the morphology of normal (untreated) neonatal piglet kidneys (control; n = 4). All changes but the interstitial edema were statistically significant if compared with the normal renal tissue: tubular dilatation (CPB vs. control P < 0.05), vacuole formation (CPB vs. control P < .05), leukocytic infiltration (CPB vs. control P < 0.05), and epithelial destruction (CPB vs. control P < 0.001). In conclusion, CPB induces significant changes in the morphology of the neonatal piglet kidneys.
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Affiliation(s)
- Theodor Tirilomis
- Department for Thoracic, Cardiac, and Vascular Surgery, University of Goettingen, Goettingen, Germany.
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Facenda A, Romero A, Lima JM, Contreras CM, Montero HDV, Lima Montero MG. Efectos de la circulación extracorpórea sobre el filtrado glomerular en la cirugía cardiovascular pediátrica. REVISTA COLOMBIANA DE CARDIOLOGÍA 2011. [DOI: 10.1016/s0120-5633(11)70182-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Gazit AZ, Huddleston CB, Checchia PA, Fehr J, Pezzella AT. Care of the pediatric cardiac surgery patient--part 2. Curr Probl Surg 2010; 47:261-376. [PMID: 20207257 DOI: 10.1067/j.cpsurg.2009.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Avihu Z Gazit
- Pediatric Critical Care Medicine and Cardiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
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Gazit AZ, Huddleston CB, Checchia PA, Fehr J, Pezzella AT. Care of the Pediatric Cardiac Surgery Patient—Part 1. Curr Probl Surg 2010; 47:185-250. [DOI: 10.1067/j.cpsurg.2009.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lema G, Vogel A, Canessa R. Cardiopulmonary bypass as a risk factor in paediatric cardiac surgical patients. Acta Anaesthesiol Scand 2008; 52:720-1. [PMID: 18419731 DOI: 10.1111/j.1399-6576.2008.01612.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Székely A, Sápi E, Breuer T, Kertai MD, Bodor G, Vargha P, Szatmári A. Aprotinin and renal dysfunction after pediatric cardiac surgery. Paediatr Anaesth 2008; 18:151-9. [PMID: 18184247 DOI: 10.1111/j.1460-9592.2007.02398.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Aprotinin is a potent antifibrinolytic drug, which reduces postoperative bleeding and transfusion requirements. Recently, two observational studies reported increased incidence of renal dysfunction after aprotinin use in adults. Therefore, the aim of the study was to investigate the safety of aprotinin use in pediatric cardiac surgery patients. METHODS Data were prospectively and consecutively collected from 657 pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The database was assessed with regard to a possible relationship between aprotinin administration and dialysis and between aprotinin and postoperative renal dysfunction [defined as 25% decrease in the creatinine clearance (Ccr) compared with the preoperative value] by propensity-score adjustment and multivariable methods. RESULTS The incidence of dialysis (9.6% vs 4.1%; P = 0.005) and renal dysfunction (26.3% vs 16.1%; P = 0.019) was higher in patients who received aprotinin; however, propensity adjusted risk ratios were not significant [odds ratio (OR) of dialysis: 1.22; 95% confidence interval (CI) 0.46-3.22; OR of renal dysfunction 1.26; 95% CI: 0.66-1.92]. Aprotinin significantly reduced blood loss in the first postoperative 24 h. The main contributors of renal dysfunction were CPB duration, cumulative inotropic support, age, preoperative Ccr, amount of transfusion and pulmonary hypertension. CONCLUSIONS Despite the higher incidences of renal dysfunction and failure in the aprotinin group, an independent role of the drug in the development of renal dysfunction or dialysis could not be demonstrated in pediatric cardiac patients undergoing CPB.
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Affiliation(s)
- Andrea Székely
- Department of Paediatric Anaesthesia and Intensive Care, Gottsegen György National Institute of Cardiology, Budapest, Hungary.
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Bibliography. Current world literature. Cardiovascular medicine. Curr Opin Pediatr 2007; 19:601-6. [PMID: 17885483 DOI: 10.1097/mop.0b013e3282f12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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