Acute kidney injury and regional abdominal perfusion during neonatal aortic arch reconstruction

Abstract

Objective: Our objective was to determine whether regional visceral perfusion during neonatal aortic arch reconstruction attenuates postoperative acute kidney injury.

Methods: A technique to provide simultaneous perfusion to the brain and viscera during aortic arch reconstruction in neonates was developed and applied (multisite perfusion). The effect of the technique on postoperative renal function was assessed by comparing the incidence of acute kidney injury in neonates undergoing multisite perfusion to a control group of neonates who underwent aortic arch reconstruction with regional cerebral perfusion alone.

Results: Thirteen neonates underwent multisite perfusion during procedures involving reconstruction of the aortic arch. Twenty-four neonates who underwent similar procedures with regional cerebral perfusion alone were selected as controls. The incidence of acute kidney injury in those undergoing multisite perfusion was 8% (n = 1), compared with 50% (n = 12) in the control group (P = .01). The median percentage change in estimated creatinine clearance was 0 (-33 to +60) in the multisite perfusion group, compared with -29 (-50 to +14) in the control group (P < .01). Patients in the multisite perfusion group were less frequently exposed to preoperative nephrotoxins and intraoperative aprotinin and had a higher prevalence of preoperative comorbidity, a shorter duration of regional cerebral perfusion, and a longer length of stay in the intensive care unit.

Conclusions: Acute kidney injury is common after reconstruction of the aortic arch in neonates. By providing direct visceral perfusion during surgery, this simple multisite perfusion technique may ameliorate acute kidney injury in these neonates. Further investigation of this technique is warranted.