Summary
The outlook for patients with cardiac surgery complicated by acute renal failure (ARF) is poor, with a reported mortality of 50–67%. In addition to assessing the impact of recent advances in pediatric cardiac surgery on the mortality rate and renal outcome of surgery complicated by ARF requiring peritoneal dialysis (PD), this study compares preoperative, operative, and postoperative variables in patients who survived surgery and those who did not survive. From 1982 through 1988, 44 postoperative cardiac patients developed ARF, and 40 (age: 2 days to 15 years) required PD. Seventeen of 40 patients survived (mortality 57.5%) and 16 of these patients recovered normal renal function. Preoperative variables, including operative age and weight, did not appear to directly influence survival. Operative profiles, including length of cardiopulmonary bypass, aortic cross-clamp time, and hypotension immediately off bypass, did not distinguish surviving patients from those that did not survive. Postoperative variables, such as postoperative hypotension treatment, arrhythmias, hematologic status, cardiac arrest with resuscitation, did not differentiate survivors from nonsurvivors. The mean duration of PD was less than 2 weeks, and compications were infrequent. Renal status following PD in survivors was usually normal.
We conclude that recent advances in pediatric cardiac surgery have not further increased the high mortality of surgery complicated by ARF. Survival is associated with renal recovery and thus aggressive treatment using PD is warranted.
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Abel RM, Buckley MJ, Austen WG, Barnett GO, Beck CH Jr, Fischer JE (1986) Etiology, incidence and prognosis of renal failure following cardiac operations.J Thorac Cardiovasc Surg 71:323–333
Book K, Ohquist G, Bjork VO, Lundberg S, Settergran G (1982) Peritoneal dialysis in infants and children after open heart surgery.Scand J Thorac Cardiovasc Surg 16:229–233
Chesney RW, Kaplan BS, Freedom RM, Haller JA, Drummond KN (1975) Acute renal failure: an important complication of cardiac surgery in infants.J Pediatr 87:381–388
Fine RN (1982) Peritoneal dialysis update.J Pediatr 100:1–7
Hanson J, Loftness S, Clarke D, Campbell D (1989) Peritoneal dialysis following open heart surgery in children.Pediatr Cardiol 10:125–128
Koning HM, Koning AJ, Levsink JA (1985) Serious acute renal failure following open heart surgery.Thorac Cardiovasc Surg 33:283–287
Krain A (1976) Incidence, prevention and treatment of acute renal failure following cardiopulmonary bypass.Int Anesthesiol Clin 14:98–101
Kron IL, Joob AW, VanMeter C (1985) Acute renal failure in the cardiovascular surgical patient.Ann Thorac Surg 39:590–598
Rigden SPA, Barratt TM, Dillon MJ, DeLeval M, Stark J (1982) Acute renal failure complicating cardiopulmonary bypass surgery.Arch Dis Child 57:425–430
Segar WE, Gibson RK, Rhamy R (1961) Peritoneal dialysis in infants and small children.Pediatrics 2:603–613
Tenckhoff H, Schechter H (1968) A bacteriologically safe peritoneal access device.Trans Am Soc Artif Intern Organs 4:181–187
Watson AR, Vigneaux A, Hardy BE, Balfe J (1985) Six year experience with CAPD catheters in children.Peritoneal Dialysis Bull 5:119–122
Wong SN, Geary DF (1988) Comparison of temporary and permanent catheters for acute peritoneal dialysis.Arch Dis Child 63:827–831
Yeboah ED, Petrie A, Peak JL (1972) Acute renal failure and open heart surgery.Br Med J 1:415–418
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Giuffre, R.M., Tam, K.H., Williams, W.W. et al. Acute renal failure complicating pediatric cardiac surgery: A comparison of survivors and nonsurvivors following acute peritoneal dialysis. Pediatr Cardiol 13, 208–213 (1992). https://doi.org/10.1007/BF00838778
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DOI: https://doi.org/10.1007/BF00838778