الفهرس 
Cardiopulmonary Bypass in Arterial switch operation for infants with transposition of great arteriesOnly 14 pages are availabe for public view
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Abstract
Abstract
Aim
Transposition of the great arteries (TGA) is a type of congenital cardiac disease that affects 4.7/10,000 livebirths. The arterial switch operation (ASO) is the most preferred surgery to repair this anomaly. Cardiopulmonary bypass (CPB) is imperative to perform the operation.
Prolonged exposure to the CPB can affect the liver, brain, kidneys, gastrointestinal tract, and heart. This study aimed to find the effect of CPB on the development of acute kidney injury (AKI) in infants with TGA who underwent the arterial switch operation (ASO) and to validate the neutrophil gelatinase- associated lipocalin (NGAL) for diagnosis of AKI.
Material and methods
A single-center study included 390 cases. All patients were classified using the pediatric Risk, Injury, Failure, loss, end stage (pRIFLE) classification to assess the incidence of AKI. 360 cases were retrospective, and thirty cases were prospective, those thirty cases were assessed three times (before the operation, immediately postoperative, and one week after operation) with the NGAL as a biomarker of renal tubular impairment.
Results
A total of 390 D-TGA patients who underwent ASO, postoperative urea, and creatinine showed a significant increase (p-value <0.001), and a significant decrease in postoperative Glomerular filtration rate (GFR) (p-value <0.001). Around 40% of the patients showed positive postoperative AKI according to pRIFLE classification. There was a significant increase in immediate and one-week postoperative NGAL levels in the thirty prospective cases. At the cut-off point serum NGAL concentration of 15.7 ng/ml, the sensitivity was 100%, and Negative predictive value (NPV) was 100%.
Conclusions
AKI is a serious complication that can occur after open-heart surgery. Postoperative NGAL level could be a good indicator for postoperative AKI.