Postoperative Renal Failure, Shunt Type, and Mortality After Norwood Palliation.
| Title: | Postoperative Renal Failure, Shunt Type, and Mortality After Norwood Palliation. |
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| Authors: | Chamberlain RC; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina. Electronic address: reid.chamberlain@duke.edu.; Andersen ND; Department of Surgery, Duke University Medical Center, Durham, North Carolina.; McCrary AW; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.; Hornik CP; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.; Hill KD; Department of Pediatrics, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. |
| Source: | The Annals of thoracic surgery [Ann Thorac Surg] 2022 Jun; Vol. 113 (6), pp. 2046-2053. Date of Electronic Publication: 2021 Sep 15. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: Netherlands NLM ID: 15030100R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-6259 (Electronic) Linking ISSN: 00034975 NLM ISO Abbreviation: Ann Thorac Surg Subsets: MEDLINE |
| Imprint Name(s): | Publication: Amsterdam : Elsevier; Original Publication: Boston. |
| MeSH Terms: | Blalock-Taussig Procedure*/adverse effects ; Hypoplastic Left Heart Syndrome*/surgery ; Norwood Procedures*/adverse effects ; Renal Insufficiency*/epidemiology ; Renal Insufficiency*/etiology; Heart Ventricles/surgery ; Pulmonary Artery/surgery ; Humans ; Randomized Controlled Trials as Topic ; Treatment Outcome |
| Abstract: | Background: The Single Ventricle Reconstruction Trial demonstrated increased risk of death or heart transplant 1 year after Norwood among subjects randomly assigned to modified Blalock-Taussig shunts compared with right ventricle to pulmonary artery (RV-PA) shunts. We used the Single Ventricle Reconstruction Trial public use database to evaluate incidence and risk factors for postoperative renal failure and relationships between renal failure, shunt type, and outcomes after Norwood.; Methods: Postoperative renal failure was defined a priori as a threefold rise in creatinine from baseline, or dialysis use, within 7 days of Norwood. We used multivariate logistic regression to evaluate risk factors for postoperative renal failure and Cox hazard regression to determine the association between postoperative renal failure and 1 year after Norwood mortality.; Results: Overall, postoperative renal failure occurred in 8.4% (46 of 544) patients with risk factors including receipt of a modified Blalock-Taussig shunt (adjusted odds ratio [aOR] 3.3, P = .02), low center volume (aOR 2.7, P = .005), two or more preoperative complications (aOR 4.0, P < .001), low birth weight (aOR 3.2, P = .002), postoperative heart block (aOR 8.5, P = .001), and delayed sternal closure (aOR 5.3, P = .026). Renal failure was an independent risk factor for 1-year mortality (aHR 1.9, P = .019). Assessing interaction by shunt type, mortality risk associated with renal failure was greatest in the RV-PA shunt group (aHR 3.3 vs RV-PA shunt without renal failure, P = .001), but was also increased in the modified Blalock-Taussig shunt group (aHR 1.9, P = .03).; Conclusions: Postoperative renal failure is common after Norwood and is independently associated with mortality. Although renal failure is more common after modified Blalock-Taussig shunt, the highest mortality risk with renal failure occurs after RV-PA shunt.; (Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.) |
| Grant Information: | T32 GM086330 United States GM NIGMS NIH HHS |
| Entry Date(s): | Date Created: 20210917 Date Completed: 20220525 Latest Revision: 20230602 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC8920938 |
| DOI: | 10.1016/j.athoracsur.2021.08.019 |
| PMID: | 34534529 |
| Database: | MEDLINE |
Journal Article