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Risk factors for low cardiac output syndrome in children with congenital heart disease undergoing cardiac surgery: a retrospective cohort study.
BMC Pediatrics ( IF 2.4 ) Pub Date : 2020-02-24 , DOI: 10.1186/s12887-020-1972-y Xinwei Du 1 , Hao Chen 1 , Xiaoqi Song 1 , Shunmin Wang 1 , Zedong Hao 2 , Lifeng Yin 2 , Zhaohui Lu 1
BMC Pediatrics ( IF 2.4 ) Pub Date : 2020-02-24 , DOI: 10.1186/s12887-020-1972-y Xinwei Du 1 , Hao Chen 1 , Xiaoqi Song 1 , Shunmin Wang 1 , Zedong Hao 2 , Lifeng Yin 2 , Zhaohui Lu 1
Affiliation
BACKGROUND
Low cardiac output syndrome (LCOS) is an important complication of cardiac surgery. It is associated with increased morbidity and mortality. The incidence of LCOS after surgery is high in patients with congenital heart disease (CHD). Therefore, determining the risk factors of LCOS has clinical significance for the management of CHD. This study aimed to analyze the risk factors of LCOS.
METHODS
We conducted a retrospective analysis of children with CHD who underwent cardiac surgery at Shanghai Children's Medical Center between January 1, 2014, and December 31, 2017. Demographic characteristics and baseline data were extracted from the health data resource center of the hospital, which integrates clinical routine data including medical records, diagnoses, orders, surgeries, laboratory tests, imaging, nursing, and other subsystems. Logistic regressions were performed to analyze the risk factors of LCOS.
RESULTS
Overall, 8660 infants with CHD were included, and 864 (9.98%) had LCOS after surgery. The multivariate regression analysis identified that age (OR 0.992, 95% CI: 0.988-0.997, p = 0.001), tricuspid regurgitation (1.192, 1.072-1.326, p = 0.001), Risk Adjustment in Congenital Heart Surgery-1 risk grade (1.166, 1.011-1.345, p = 0.035), aortic shunt (left-to-right: 1.37, 1.005-1.867, p = 0.046; bi-directional: 1.716, 1.138-2.587, p = 0.01), atrial shunt (left-to-right: 1.407, 1.097-1.805, p = 0.007; right-to-left: 3.168, 1.944-5.163, p < 0.001; bi-directional: 1.87, 1.389-2.519, p < 0.001), ventricular level shunt (left-to-right: 0.676, 0.486-0.94, p = 0.02; bi-directional: 2.09, 1.611-2.712, p < 0.001), residual shunt (3.489, 1.502-8.105, p = 0.004), left ventricular outflow tract obstruction (3.934, 1.673-9.254, p = 0.002), right ventricular outflow tract obstruction (3.638, 1.225-10.798, p = 0.02), circulating temperature (mild hypothermia: 1.526, 95% CI: 1.205-1.934, p < 0.001; middle and low temperature: 1.738, 1.236-2.443, p = 0.001), duration of cardiopulmonary bypass (1.009, 1.006-1.012, p < 0.001), myocardial preservation using histidine-tryptophan-ketoglutarate (1.677, 1.298-2.167, p < 0.001), and mitral insufficiency (1.714, 1.239-2.37, p < 0.001) were independent risk predictors of LCOS.
CONCLUSIONS
The incidence of postoperative LCOS in CHD children remains high. Circulation temperature, myocardial preservation using histidine-tryptophan-ketoglutarate, and usage of residual shunt after surgery were independent risk predictors for LCOS.
中文翻译:
先天性心脏病患儿接受心脏手术的儿童低心输出量综合征的危险因素:一项回顾性队列研究。
背景技术低心输出量综合征(LCOS)是心脏手术的重要并发症。它与发病率和死亡率增加相关。先天性心脏病(CHD)患者术后LCOS的发生率很高。因此,确定LCOS的危险因素对冠心病的治疗具有临床意义。本研究旨在分析LCOS的危险因素。方法对2014年1月1日至2017年12月31日在上海儿童医学中心进行心脏手术的冠心病患儿进行回顾性分析。从医院健康数据资源中心提取人口统计学特征和基线数据临床常规数据,包括病历,诊断,命令,手术,实验室检查,影像,护理和其他子系统。进行逻辑回归分析LCOS的危险因素。结果总体上,包括8660例冠心病婴儿,术后864例(9.98%)患有LCOS。多元回归分析确定年龄(OR 0.992,95%CI:0.988-0.997,p = 0.001),三尖瓣关闭不全(1.192,1.072-1.326,p = 0.001),先天性心脏病手术的风险调整-1风险等级(1.166) ,1.011-1.345,p = 0.035),主动脉分流(从左至右:1.37,1.005-1.867,p = 0.046;双向:1.716,1.138-2.587,p = 0.01),心房分流(从左至右-右:1.407,1.097-1.805,p = 0.007;右至左:3.168,1.944-5.163,p <0.001;双向:1.87,1.389-2.519,p <0.001),心室分流(左-从右至右:0.676,0.486-0.94,p = 0.02;双向:2.09,1.611-2.712,p <0.001),残余分流(3.489,1.502-8.105,p = 0.004),左心室流出道梗阻(3.934,1.673-9.254,p = 0.002),右心室流出道梗阻(3.638,1.225-10.798,p = 0.02),循环温度(轻度低温:1.526,95%CI:1.205-1.934, p <0.001;中低温:1.738,1.236-2.443,p = 0.001),心肺旁路持续时间(1.009,1.006-1.012,p <0.001),使用组氨酸-色氨酸-酮戊二酸酯保存心肌(1.677,1.298-2.167) (p <0.001)和二尖瓣关闭不全(1.714,1.239-2.37,p <0.001)是LCOS的独立危险因素。结论冠心病儿童术后LCOS的发生率仍然很高。循环温度,使用组氨酸-色氨酸-酮戊二酸保存心肌以及术后残余分流的使用是LCOS的独立危险因素。
更新日期:2020-02-24
中文翻译:
先天性心脏病患儿接受心脏手术的儿童低心输出量综合征的危险因素:一项回顾性队列研究。
背景技术低心输出量综合征(LCOS)是心脏手术的重要并发症。它与发病率和死亡率增加相关。先天性心脏病(CHD)患者术后LCOS的发生率很高。因此,确定LCOS的危险因素对冠心病的治疗具有临床意义。本研究旨在分析LCOS的危险因素。方法对2014年1月1日至2017年12月31日在上海儿童医学中心进行心脏手术的冠心病患儿进行回顾性分析。从医院健康数据资源中心提取人口统计学特征和基线数据临床常规数据,包括病历,诊断,命令,手术,实验室检查,影像,护理和其他子系统。进行逻辑回归分析LCOS的危险因素。结果总体上,包括8660例冠心病婴儿,术后864例(9.98%)患有LCOS。多元回归分析确定年龄(OR 0.992,95%CI:0.988-0.997,p = 0.001),三尖瓣关闭不全(1.192,1.072-1.326,p = 0.001),先天性心脏病手术的风险调整-1风险等级(1.166) ,1.011-1.345,p = 0.035),主动脉分流(从左至右:1.37,1.005-1.867,p = 0.046;双向:1.716,1.138-2.587,p = 0.01),心房分流(从左至右-右:1.407,1.097-1.805,p = 0.007;右至左:3.168,1.944-5.163,p <0.001;双向:1.87,1.389-2.519,p <0.001),心室分流(左-从右至右:0.676,0.486-0.94,p = 0.02;双向:2.09,1.611-2.712,p <0.001),残余分流(3.489,1.502-8.105,p = 0.004),左心室流出道梗阻(3.934,1.673-9.254,p = 0.002),右心室流出道梗阻(3.638,1.225-10.798,p = 0.02),循环温度(轻度低温:1.526,95%CI:1.205-1.934, p <0.001;中低温:1.738,1.236-2.443,p = 0.001),心肺旁路持续时间(1.009,1.006-1.012,p <0.001),使用组氨酸-色氨酸-酮戊二酸酯保存心肌(1.677,1.298-2.167) (p <0.001)和二尖瓣关闭不全(1.714,1.239-2.37,p <0.001)是LCOS的独立危险因素。结论冠心病儿童术后LCOS的发生率仍然很高。循环温度,使用组氨酸-色氨酸-酮戊二酸保存心肌以及术后残余分流的使用是LCOS的独立危险因素。