RESUMO
OBJECTIVE: The objective of this study was to evaluate the available data on long-term kidney dysfunction, hypertension, and mortality after cardiac surgery-associated acute kidney injury (AKI) in the pediatric population. STUDY DESIGN: PubMed/MEDLINE, Embase, Scopus, and reference lists of relevant articles were searched for eligible studies published from inception through March 2022. Long-term outcomes after pediatric cardiac surgery complicated by AKI and those without were investigated. RESULTS: We identified 14 studies published between 2013 and 2022 that included a total of 6701 patients (AKI: 1376 patients; no AKI: 5325 patients). These studies used different well-established classifications to define AKI. All the studies suggested that AKI after heart surgery is common in the pediatric patient population and reported a potential link between cardiac surgery-associated AKI and important clinical outcomes. However, only 4 out of 11 studies found a strong association between (absence of recovery from) cardiac surgery-associated AKI and risk of developing chronic kidney disease, and 3 out of 5 studies found a significant increase in mortality rates for pediatric patients who developed AKI after cardiac surgery. Only 1 out of 4 studies found an association between AKI and hypertension at 12 months postoperatively, but found no association at later follow-up times. CONCLUSIONS: Although there is a trend, evidence on the long-term consequences of cardiac surgery-associated AKI in the pediatric population is mixed. Genetic syndromes, preexisting kidney disease, univentricular or cyanotic heart conditions, and/or high-complexity surgery may be more important for the development of kidney dysfunction by adolescence and early adulthood. Regardless, these children may benefit from a long-term kidney follow-up.
Assuntos
Injúria Renal Aguda , Procedimentos Cirúrgicos Cardíacos , Hipertensão , Insuficiência Renal Crônica , Adolescente , Criança , Humanos , Adulto , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Insuficiência Renal Crônica/complicações , Hipertensão/complicações , Fatores de Risco , Estudos RetrospectivosRESUMO
OBJECTIVE: To assess the effects of preterm birth on cardiac structure and function and transplant-free survival in patients with hypoplastic left heart syndrome and associated anomalies throughout the staged palliation process. STUDY DESIGN: Data from the Single Ventricle Reconstruction trial were used to assess the impact of prematurity on echocardiographic measures at birth, Norwood, Stage II, and 14 months in 549 patients with a single functional right ventricle. Medical history was recorded once a year using medical records or telephone interviews. Cox regression models were applied to analyze transplant-free survival to age 6 years. Causal mediation analysis was performed to estimate the mediating effect of birth weight within this relationship. RESULTS: Of the 549 participants, 64 (11.7%) were born preterm. Preterm-born participants had lower indexed right ventricle end-diastolic volumes at birth but higher volumes than term-born participants by age 14 months. Preterm-born participants had an increased risk of death or heart transplantation from birth to age 6 years, with an almost linear increase in the observed risk as gestational age decreased below 37 weeks. Of the total effect of preterm birth on transplant-free survival, 27.3% (95% CI 2.5-59.0%) was mediated through birth weight. CONCLUSIONS: Preterm birth is associated with adverse right ventricle remodeling and worse transplant-free survival throughout the palliation process, in part independently of low birth weight. Further investigation into this vulnerable group may allow development of strategies that mitigate the impact of prematurity on outcomes in patients with hypoplastic left heart syndrome.
Assuntos
Síndrome do Coração Esquerdo Hipoplásico , Procedimentos de Norwood , Nascimento Prematuro , Coração Univentricular , Feminino , Humanos , Recém-Nascido , Criança , Lactente , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Peso ao Nascer , Ventrículos do Coração/anormalidades , Remodelação Ventricular , Resultado do TratamentoRESUMO
OBJECTIVE: To investigate whether a single educational session increased the level of knowledge and changed the prevalence of health risk behaviors in young people with congenital heart disease (CHD). STUDY DESIGN: We conducted a longitudinal study of patients transferred to adult CHD care who received a single educational session (n = 201) at a tertiary care center. Their knowledge level and prevalence of health risk behaviors were assessed via the Leuven Knowledge Questionnaire CHD and the Health Behavior Scale CHD, respectively. A general linear model for longitudinal measurements was used to analyze the natural progression of patients' knowledge during a 27-month period and the effect of one educational session on outcomes. RESULTS: Participating in an educational session resulted in a small-to-moderate, but significant, increase in total knowledge level and better understanding of deterioration symptoms, and rationale and frequency of follow-up; however, it did not improve patients' health behaviors. CONCLUSIONS: This type of education did improve knowledge but did not improve the patients' tendency to engage in better health behaviors. Future studies should assess the effect of repetitive exposure to educational sessions dealing with CHD.