Prophylactic Peritoneal Dialysis after the Arterial Switch Operation: A retrospective cohort study

Gist KM, Henry BM, Borasino S, Rahman AF, Webb T, Hock KM, Kim JS, Smood B, Mosher Z, Alten JA.Ann Thorac Surg. 2020 May 27:S0003-4975(20)30757-8. doi: 10.1016/j.athoracsur.2020.04.028. Online ahead of print.PMID: 32473128



Background: Fluid overload contributes to poor outcomes after neonatal cardiac surgery. The optimal strategy to mitigate fluid overload related morbidity is unknown. The utility of prophylactic peritoneal dialysis remains controversial. We aimed to assess the impact of prophylactic peritoneal dialysis on outcomes and hypothesized that prophylactic dialysis would be associated with less fluid overload and improved outcomes in neonates undergoing the arterial switch operation.

Methods: A Single center retrospective analysis of 41 consecutive neonates between 6/2010-3/2016 undergoing the arterial switch operation was performed. Fluid balance and other outcomes were compared between those receiving peritoneal dialysis (n=25) vs. those who did not (n=16).

Results: Demographics were similar between groups, except cardiopulmonary bypass duration which was significantly longer in the dialysis group (125±20 minutes) compared to the no dialysis group (109±15 minutes)(p = 0.01). Median time to dialysis initiation and termination from cardiac intensive care unit admission were 9.1 hours (IQR:7-9.8) and 58.7 hours (IQR:44-76.1) respectively. Cumulative fluid balance in the dialysis group was significantly more negative compared to the no dialysis group across all 7 post-operative days. In the multivariable analysis, use of dialysis was associated with a 42% (RR:0.58, 95% CI: 0.4-0.85, p < 0.01) and 34% (RR:0.66, 95% CI:0.47-0.94, p = 0.02) reduction in hours of mechanical ventilation and intensive care length of stay respectively. Utilization of dialysis was associated with lower hospital costs (p< 0.01).

Conclusions: Prophylactic peritoneal dialysis after the arterial switch operation is associated with improved post-operative outcomes without increased hospital costs (Visual Abstract).