Renal function of patients with a failing Fontan circuit undergoing total cavopulmonary revision surgery.
This report characterizes renal dysfunction after total cavopulmonary (TCPC) revision surgery for atriopulmonary Fontan (APF) circulations, a known risk factor for a poor outcome. The perioperative data for 23 consecutively identified patients were reviewed. The preoperative mean glomerular filtration rate (GFR) was 101 +/- 30 ml/min/1.73 m(2), decreasing to 65 +/- 41 ml/min/1.73 m(2) early in the postoperative period. The preoperative GFR was highly correlated with age at APF (r = -0.5; p = 0.024), age at TCPC (r = -0.5; p = 0.01), and mixed venous saturation (r = 0.6; p = 0.01). Three of four patients requiring renal replacement therapy (RRT) died at a median age of 3 months (range, 18 days to 9 months). Determinants of early GFR and RRT were preoperative GFR (p = 0.016) and creatinine (p = 0.035). Younger age at primary Fontan (p = 0.008), higher preoperative mixed venous saturation (p = 0.019), and higher preoperative blood pressure (p = 0.006) independently predicted better GFRs at the latest follow-up evaluation. Renal function declines acutely after TCPC revision, often necessitating RRT. A requirement for RRT marks greater mortality. Higher preoperative creatinine levels identify those at greatest risk.
Sammour
Fatin
F
Wessex Adult Congenital Heart Unit, Southampton University Hospital, Southampton, UK. f.sammour@doctors.org.uk
Haw
Marcus
M
Paisey
John
J
Cope
Richard
R
Herbertson
Mike
M
Salmon
Tony
T
Vettukattil
Joseph
J
Rogerson
Mary
M
Karagkiozaki
Varvara
V
Veldtman
Gruschen
G
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects*; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D051437:Renal Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D017211:Treatment Failure; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult