Close
Enter your
text here

Acute Kidney Injury After Comprehensive Stage Two Palliation in Infants With Hypoplastic Left Heart Syndrome

Acute Kidney Injury After Comprehensive Stage Two Palliation in Infants With Hypoplastic Left Heart Syndrome 150 150 JoAnna Pendergrass, DVM

Infants with hypoplastic left heart syndrome who undergo the Hybrid pathway palliation commonly develop acute kidney injury after the comprehensive stage 2 procedure and may require advanced medical therapy.

 

In a recent Cardiology in the Young publication, Andrew Yates, MD, associate medical director for the Cardiothoracic Intensive Care Unit at Nationwide Children’s Hospital, and his research team reported that infants with hypoplastic left heart syndrome (HLHS) commonly developed acute kidney injury after the comprehensive stage 2 (Comp 2) procedure of the Hybrid pathway.

The Hybrid pathway has recently emerged as an alternative to the Norwood procedure, which is one of the traditional surgical approaches for HLHS. The Norwood often results in high morbidity and mortality rates. The Hybrid pathway comprises the Hybrid stage 1 and Comp 2 procedures and reportedly delays the development of postoperative acute kidney injury after the neonatal period.

Acute kidney injury is a common postoperative complication for congenital heart disease, due in large part to the cardiopulmonary bypass that is required for these palliative procedures.

“Cardiopulmonary bypass causes changes in hemodynamics and inflammatory responses, increasing the risk of postoperative acute kidney injury,” explains Dr. Yates.

The researchers analyzed the data of 61 infants with hypoplastic left heart syndrome who underwent the Hybrid pathway and completed the Comp 2 procedure at Nationwide Children’s from 2009 to 2018.

The Kidney Diseases Improving Global Outcomes criteria were used to classify the patients’ acute kidney injury as stage 1, stage 2, or stage 3. Stages 2 and 3 were classified as severe acute kidney injury.

Other data collected included demographic information, fluid overload percentage, vasoactive inotrope score and medical interventions for acute kidney injury.

Most patients in the cohort were male (66%) and white (75%). The cumulative incidence of acute kidney injury after the Hybrid stage 1 and Comp 2 procedures was 69%, with approximately 36% of these patients developing severe acute kidney injury.

Acute kidney injury developed more frequently after the Comp 2 procedure than the Hybrid stage 1 procedure.

Thirty-day mortality was statistically similar between patients with acute kidney injury (8%) and those without (9%). However, patients with acute kidney injury experienced more morbidity and required more medical intervention during their hospital stay, including diuretics and vasoactive support.

”Although there was a high incidence of acute kidney injury in patients undergoing the Hybrid pathway, the patients’ survival and outcomes were very good,” Dr. Yates notes, adding that this incidence is similar to that found with other palliative approaches for single ventricle physiology.

The researchers are continuing to analyze these patients’ data. Specifically, they are comparing the urinary biomolecules between patients who underwent the Comp 2 procedure and those who underwent the Glenn procedure as stage 2 palliation.

“With this research,” Dr. Yates says, “we are trying to determine which areas of the kidneys were injured after these palliative procedures and develop different approaches to mitigate those adverse changes in the kidneys.”

 

Reference

Cunningham TW, Bai S, Krawczeski CD, Spencer JD, Phelps C, Yates AR. Acute kidney injury in hypoplastic left heart syndrome patients following the comprehensive stage two palliation. Cardiology in the Young. 2023 Aug 11:1-7.

 

About the author

JoAnna Pendergrass

JoAnna Pendergrass, DVM, is a veterinarian and freelance medical writer in Atlanta, GA. She received her veterinary degree from the Virginia-Maryland College of Veterinary Medicine and completed a 2-year postdoctoral research fellowship at Emory University’s Yerkes Primate Research Center before beginning her career as a medical writer.

As a freelance medical writer, Dr. Pendergrass focuses on pet owner education and health journalism. She is a member of the American Medical Writers Association and has served as secretary and president of AMWA’s Southeast chapter.

In her spare time, Dr. Pendergrass enjoys baking, running, and playing the viola in a local community orchestra.

You might also like