Impact of additional myocardial perfusion on renal function after neonatal arch repair

Vollständiger Abstract

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Introduction Myocardial protection during neonatal aortic arch repair may influence postoperative cardiac function and subsequent systemic organ perfusion. We investigated whether the addition of myocardial perfusion during arch repair is associated with improved postoperative renal function in neonates. Methods We retrospectively analyzed neonates, including premature infants who underwent surgery beyond the neonatal period after reaching an appropriate corrected gestational age, who underwent aortic arch repair with associated simple defects under cardiopulmonary bypass (CPB) between 2008 and 2019. All patients received selective cerebral perfusion, and additional myocardial perfusion was selectively applied. Acute kidney injury (AKI) was defined using the pediatric modified RIFLE criteria. Multivariable analysis and propensity score matching were performed to evaluate the association between perfusion strategy and renal function. Results A total of 202 patients (median age 9 days, weight 3.1 kg) were included. Additional myocardial perfusion was used in 96 patients (47.5%). Postoperative AKI occurred in 49 patients (24.3%). In multivariable analysis, prematurity was associated with increased risk of AKI (odds ratio [OR] 2.669; 95% confidence interval [CI] 1.107–6.433; p = 0.029), whereas additional myocardial perfusion was associated with reduced risk (OR 0.397; 95% CI 0.196–0.806; p = 0.011). Longer CPB time showed a marginal association ( p = 0.054). In propensity-matched cohorts, recovery of estimated creatinine clearance was significantly faster in patients receiving additional myocardial perfusion ( p < 0.001). Conclusions AKI is not uncommon after aortic arch repair under CPB in neonates. The use of additional myocardial perfusion was associated with a reduced risk of postoperative AKI and improved recovery of renal function. Prematurity remained an independent risk factor for postoperative AKI.