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Abstract

Introduction

Cardiac surgery-associated acute kidney injury (CSA-AKI) remains a serious complication. The ratio of the venous-arterial carbon dioxide partial pressure difference (Pv-aCO₂) to the arterial-venous oxygen content difference (Ca-vO₂) is an indicator of tissue perfusion and anaerobic metabolism. We aimed to assess whether peak Pv-aCO₂/Ca-vO₂ during cardiopulmonary bypass (CPB) predicts CSA-AKI in pediatric patients with cyanotic congenital heart disease (CHD).

Methods

We retrospectively reviewed patients aged < 10 years with cyanotic CHD who underwent cardiac surgery with CPB between January 2019 and August 2024. Peak Pv-aCO₂/Ca-vO₂ during CPB was analyzed for its association with CSA-AKI using multivariate logistic regression adjusted for age, weight, CPB duration, aortic cross-clamp (ACC) time, and red blood cell transfusion. Classification and regression tree (CART) analysis was conducted to develop a predictive model.

Results

This study included 191 patients (96 (50.3 %) males; median age: 196 days [interquartile range (IQR), 55–474]). CSA-AKI occurred in 65 patients (34.0 %). Peak Pv-aCO₂/Ca-vO₂ was higher in the AKI group than in the non-AKI group (IQR, 4.8 [3.9–7.5] vs 3.9 [2.8–5.4] mmHg·dL/mL; p = 0.001) and was significantly associated with CSA-AKI (adjusted odds ratio: 1.14; 95% confidence interval: 1.04–1.27). A CART-derived predictive model included ACC time, peak Pv-aCO₂/Ca-vO₂, and weight. A Pv-aCO₂/Ca-vO₂ cut-off of 4.0 mmHg·dL/mL yielded 36.9 % sensitivity, 96.0 % specificity, 82.8 % positive predictive value, and 75.9 % negative predictive value.

Conclusions

In pediatric cardiac surgery for cyanotic CHD, high Pv-aCO₂/Ca-vO₂ predicts CSA-AKI. These findings highlight the potential role of Pv-aCO₂/Ca-vO₂ monitoring during CPB in developing novel pediatric goal-directed perfusion strategies.

Keywords

cardiac surgery-associated acute kidney injury cyanotic congenital heart disease pediatric cardiac surgery cardiopulmonary bypass renal outcomes

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Prediction of cardiac surgery-associated acute kidney injury in cyanotic congenital heart disease

Abstract

Introduction

Methods

Results

Conclusions

Keywords

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References