Peritoneal dialysis after surgery for congenital heart disease in infants and young children.

BACKGROUND: We determined the risk factors for peritoneal dialysis (PD) in young children undergoing open heart surgery and, in those patients requiring PD, factors associated with prolonged PD and mortality.
METHODS: The clinical records of 182 children, aged 3 years or younger, who had undergone open heart surgery during a 2-year period were reviewed. Demographic data, preoperative risk factors, intraoperative variables, and postoperative complications were compared between patients requiring PD and those who did not, and between survivors and nonsurvivors of PD.
RESULTS: Of the 182 patients, 31 (17%) required PD. Patients requiring PD were lighter and more likely to have required preoperative ventilation; had undergone more complex surgery requiring longer bypass and circulatory arrest; and had experienced a pulmonary hypertensive crisis (p < 0.01). Logistic regression identified circulatory arrest (relative risk, 9.4; p = 0.002), cardiopulmonary bypass duration (relative risk, 1.02; p = 0.028), and low cardiac output syndrome (relative risk, 12.9; p < 0.0001) as significant determinants. Peritoneal dialysis was effective in achieving negative fluid balance, although serum urea and creatinine levels remained static. Prolonged PD was associated with younger age, higher preoperative serum creatinine, higher postoperative oxygen requirement, postoperative pulmonary hypertensive crisis, and low cardiac output syndrome (p < 0.05). When compared with survivors (n = 22), nonsurvivors (n = 9) were more likely to have had syndrome disorders and required preoperative ventilation and higher postoperative ventilatory settings (p < 0.05).
CONCLUSIONS: Risk factors for PD in young children undergoing open heart surgery are circulatory arrest, cardiopulmonary bypass duration, and low cardiac output syndrome. The preoperative and postoperative cardiopulmonary status has a significant bearing on PD duration and patient survival.