OBJECTIVES It is believed that management of neonates with dextro-transposition of the great arteries is constantly improving. Renal function may play a role in the prognosis of patients after congenital heart surgery. The aim of this study was to describe the outcome of neonates who underwent arterial switch operation during the past 2 decades using renal function as a surrogate marker for morbidity and mortality. DESIGN Retrospective cohort study. SETTING Dedicated cardiac ICU of a university-affiliated pediatric medical center. PATIENTS Infants who underwent arterial switch surgery in 1993-2015. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The cohort included 336 infants who underwent arterial switch operation for dextro-transposition of the great arteries (n = 169, 50%), transposition of the great arteries/ventricular septal defect (n = 133, 40%), or Taussig-Bing anomaly (n = 34, 10%). Between 1993-1998 and 2012-2015, the mean minimal postoperative estimated glomerular filtration rate rose from 30 mL/min/1.73 m to 40 mL/min/1.73 m (p < 0.05), and the proportion of patients with estimated glomerular filtration rate less than 30 mL/min/1.73 m decreased from 56% to 23% (p < 0.05). The daily furosemide dosage decreased from 4 mg/kg/d to 0.5 mg/kg/d (p < 0.05). Urinary output on operative day 0 decreased over time, but urinary output on operative day 2 significantly increased. Maximal lactate levels and time to lactate normalization decreased steadily. Dialysis was performed in only a few patients in the early periods, and in none in the last 6 years. The mean mortality rate of patients with dextro-transposition of the great arteries and transposition of the great arteries/ventricular septal defect decreased to 2.7% in the last 6 years. The odds ratio of a prolonged hospital stay (≥ 28 d) in a patient with estimated glomerular filtration rate less than 30 mL/min/1.73 m was 18.79, and in a patient with transposition of the great arteries/ventricular septal defect, 3.39. The odds ratio of dying after Rashkind atrial septostomy was 4.42. CONCLUSIONS During the past 2 decades, there has been significant improvement in outcome of patients undergoing transposition of the great arteries repair. Renal function was found to be a good prognostic marker of morbidity and mortality.

中文翻译：

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大动脉移位-我们做得更好吗？在20年的动脉切换操作中将结果与肾功能变化相关联。

目的人们认为，右大动脉右旋移位的新生儿管理正在不断改善。肾功能可能在先天性心脏手术后患者的预后中起作用。这项研究的目的是描述在过去的20年中使用肾功能作为发病率和死亡率的替代指标进行动脉转换手术的新生儿的结局。设计回顾性队列研究。设置大学附属小儿医学中心的专用心脏ICU。患者1993-2015年接受动脉转换手术的婴儿。干预措施无。测量和主要结果该队列包括336例接受大动脉右旋转位手术的婴儿（n = 169，50％），大动脉/室间隔缺损（n = 133，40％）或Taussig-Bing异常（n = 34，10％）的移位。在1993-1998年至2012-2015年期间，平均最低术后估计肾小球滤过率从30 mL / min / 1.73 m上升至40 mL / min / 1.73 m（p <0.05），估计肾小球滤过率的患者比例小于30 mL / min / 1.73 m的样品从56％降至23％（p <0.05）。速尿的每日剂量从4 mg / kg / d降至0.5 mg / kg / d（p <0.05）。手术第0天的尿量随时间减少，但手术第2天的尿量显着增加。最大乳酸水平和达到乳酸正常化的时间稳步下降。早期仅对少数患者进行了透析，而在最近的6年中均未进行透析。在过去6年中，右大动脉右旋移位和大动脉/室间隔缺损移位的患者的平均死亡率降至2.7％。肾小球滤过率估计低于30 mL / min / 1.73 m的患者，延长住院时间（≥28 d）的比值比是18.79，而患有大动脉/室间隔缺损的移位患者的比值比是3.39。Rashkind房间隔造瘘术后死亡的比值比是4.42。结论在过去的20年中，进行大动脉修复移位的患者的预后显着改善。发现肾功能是发病率和死亡率的良好预后标志。最近6年的7％。肾小球滤过率估计低于30 mL / min / 1.73 m的患者，延长住院时间（≥28 d）的比值比是18.79，而患有大动脉/室间隔缺损的移位患者的比值比是3.39。Rashkind房间隔造瘘术后死亡的比值比是4.42。结论在过去的20年中，进行大动脉修复移位的患者的预后显着改善。发现肾功能是发病率和死亡率的良好预后标志。最近6年的7％。肾小球滤过率估计低于30 mL / min / 1.73 m的患者，延长住院时间（≥28 d）的比值比是18.79，而患有大动脉/室间隔缺损的移位患者的比值比是3.39。Rashkind房间隔造瘘术后死亡的比值比是4.42。结论在过去的20年中，进行大动脉修复移位的患者的预后显着改善。发现肾功能是发病率和死亡率的良好预后标志。Rashkind房间隔造瘘术后死亡的比值比是4.42。结论在过去的20年中，进行大动脉修复移位的患者的预后显着改善。发现肾功能是发病率和死亡率的良好预后标志。Rashkind房间隔造瘘术后死亡的比值比是4.42。结论在过去的20年中，进行大动脉修复移位的患者的预后显着改善。发现肾功能是发病率和死亡率的良好预后标志。