[Surgery of congenital heart defects in deep hypothermic cardiovascular arrest: postoperative renal function]

We investigated early postoperative renal function in 55 consecutive infants who underwent cardiac surgery in deep hypothermic circulatory arrest (DHCA). In 15 of these patients detailed studies of glomerular and tubular function of the kidneys were performed. Mean time of circulatory arrest at 20 degrees Celsius rectal temperature was 53 +/- 15 minutes. Acute renal failure was seen in four patients due to cardiogenic shock from which they died on the second and third postoperative day. Urine flow in the surviving 51 infants ranged from 120 to 150 ml/h/1.73 m2. The preoperative creatinine clearance was 50 +/- 23 ml/min/1.73 m2. Postoperatively, creatinine clearance was slightly decreased (42 +/- 16 ml/min/1.73 m2), but had completely recovered after 7 days. The renal transport of phosphate, glucose and uric acid remained unchanged. There was a marked increase in urinary excretion of protein, albumin, alpha-1-microglobin and N-acetyl-glucosaminidase which peaked 7 hours after the operation and then normalized. If sufficient surgical hemodynamics are provided postoperatively, there is only slight impairment of glomerular and tubular function, which demonstrates that DHCA has no negative effect on renal function.