Transposition of the Great Arteries Are We Doing Better? Correlating Outcome to Change in Renal Function Over 2 Decades of Arterial Switch Operation
Objectives: It is believed that management of neonates with dextro transposition of the great arteries is constantly improving. Renal function may play a role in the prognosis of patients after congenital heart surgery. The aim of this study was to describe the outcome of neonates who underwent arterial switch operation during the past 2 decades using renal function as a surrogate marker for morbidity and mortality. Design: Retrospective cohort study. Setting: Dedicated cardiac ICU of a university affiliated pediatric medical center. Patients: Infants who underwent arterial switch surgery in 1993 2015. Interventions: None. Measurements and Main Results: The cohort included 336 infants who underwent arterial switch operation for dextro transposition of the great arteries (n 169, 50% transposition of the great arteries/ventricular septal defect (n 133, 40% or Taussig Bing anomaly (n 34, 10% Between 1993 1998 and 2012 2015, the mean minimal postoperative estimated glomerular filtration rate rose from 30 mL/min/1.73 m2 to 40 mL/min/1.73 m2 (p 0.05) and the proportion of patients with estimated glomerular filtration rate less than 30 mL/min/1.73 m2 decreased from 56% to 23% (p 0.05) The daily furosemide dosage decreased from 4 mg/kg/d to 0.5 mg/kg/d (p 0.05) Urinary output on operative day 0 decreased over time, but urinary output on operative day 2 significantly increased. Maximal lactate levels and time to lactate normalization decreased steadily. Dialysis was performed in only a few patients in the early periods, and in none in the last 6 years. The mean mortality rate of patients with dextro transposition of the great arteries and transposition of the great arteries/ventricular septal defect decreased to 2.7% in the last 6 years. The odds ratio of a prolonged hospital stay 28 d) in a patient with estimated glomerular filtration rate less than 30 mL/min/1.73 m2 was 18.79, and in a patient with transposition of the great arteries/ventricular septal defect, 3.39. The odds ratio of dying after Rashkind atrial septostomy was 4.42. Conclusions: During the past 2 decades, there has been significant improvement in outcome of patients undergoing transposition of the great arteries repair. Renal function was found to be a good prognostic marker of morbidity and mortality.
Pediatric critical care medicine a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies