Effects of N -acetylcysteine on renal dysfunction in neonates undergoing the arterial switch operation

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 139; no. 4; pp. 956 - 961
• Main Authors: Aiyagari, Ranjit, MD, Gelehrter, Sarah, MD, Bove, Edward L., MD, Ohye, Richard G., MD, Devaney, Eric J., MD, Hirsch, Jennifer C., MD, Gurney, James G., PhD, Charpie, John R., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.04.2010; AATS/WTSA
• Subjects: Acetylcysteine - therapeutic use; Antioxidants - therapeutic use; Cardiac Surgical Procedures - adverse effects; Cardiothoracic Surgery; Double-Blind Method; Female; Humans; Infant, Newborn; Kidney Diseases - etiology; Kidney Diseases - prevention & control; Male; Pilot Projects; Transposition of Great Vessels - surgery; dextro-transposition of the great arteries; NAC; d-TGA; CPB; arterial switch operation; cardiopulmonary bypass; ASO; N-acetylcysteine
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2009.09.025

Objective We evaluated N -acetylcysteine, a potent antioxidant, as prevention for renal dysfunction in infants undergoing cardiac surgery for dextro-transposition of the great arteries. Methods Twenty-one neonates undergoing the arterial switch operation were randomized to receive either placebo or intravenous N -acetylcysteine. Serial data were collected on fluid balance, serum creatinine, inotropic support, cardiac output, and length of stay. Results Hospital and 30-day survival was 100%. No serious adverse events were attributable to the drug. Subjects treated with N -acetylcysteine had a higher urine output at 24 hours (175 mL vs 96 mL; P < .01) and a shorter median time to first negative fluid balance (27 hours vs 39.5 hours; P = .02). There were no differences between groups in diuretic therapy, inotropic support, fluid intake, or chest tube output. Serum creatinine increased at 24 hours after the operation by a mean of 0.27 mg/dL with placebo ( P < .01) but was unchanged with N -acetylcysteine treatment. By postoperative day 3, serum creatinine increased by 92% in the placebo group but only 38% in the N -acetylcysteine group ( P = .04). Length of intensive care unit stay was shorter by an average of 5 days ( P  = .04) with N -acetylcysteine treatment. Conclusions In this pilot study, perioperative treatment with N -acetylcysteine resulted in improved urine output, shorter time to negative fluid balance, and attenuation of the rise in creatinine. These effects of N -acetylcysteine may translate to improved outcomes for infants undergoing complex cardiac operations.