Renal function of patients with a failing Fontan circuit undergoing total cavopulmonary revision surgery

Sammour, Fatin, Haw, Marcus, Paisey, John, Cope, Richrad, Hertbertson, Mike, Salmon, Tony, Vettukattil, Joseph, Rogerson, Mary, Karagkiozaki, Varvara and Veldtman, Gruschen (2008) Renal function of patients with a failing Fontan circuit undergoing total cavopulmonary revision surgery. Pediatric Cardiology, 30 (3), 282-288. (doi:10.1007/s00246-008-9344-7).

Abstract

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 m2, decreasing to 65 ± 41 ml/min/1.73 m2 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.

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