Risk factors of postoperative low cardiac output syndrome in children with congenital heart disease: A systematic review and meta-analysis

Peiying Wang; Cangcang Fu; Guannan Bai; Linbo Cuan; Xiaomin Tang; Chendi Jin; Hongchong Jin; Jihua Zhu; Chunhong Xie

doi:10.3389/fped.2022.954427

Risk factors of postoperative low cardiac output syndrome in children with congenital heart disease: A systematic review and meta-analysis

Front Pediatr. 2023 Jan 10:10:954427. doi: 10.3389/fped.2022.954427. eCollection 2022.

Authors

Peiying Wang¹, Cangcang Fu², Guannan Bai³, Linbo Cuan¹, Xiaomin Tang¹, Chendi Jin⁴, Hongchong Jin³, Jihua Zhu¹, Chunhong Xie⁵

Affiliations

¹ Department of Pediatric Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
² Department of Nursing, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
³ The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
⁴ Cardiac Intensive Care Unit, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
⁵ Department of Cardiovascular Medicine, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.

Abstract

Background: Low cardiac output syndrome (LCOS) is the most common complication after cardiac surgery, which is associated with the extension of postoperative hospital stay and postoperative death in children with congenital heart disease (CHD). Although there are some studies on the risk factors of LCOS in children with CHD, an unified conclusion is lack at present.

Purposes: To synthesize the risk factors of LCOS after CHD in children, and to provide evidence-based insights into the early identification and early intervention of LCOS.

Methods: The databases of the China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), PubMed, Cochrane Library, Embase and Web of Science were searched for relevant articles that were published between the establishing time of each database and January 2022. Based on retrospective records or cohort studies, the influencing factors of postoperative low cardiac output in children with congenital heart disease were included in Meta analysis.This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was evaluated according to the Newcastle-Ottawa Scale (NOS). RevMan 5.4 software was used to conduct the meta-analysis.

Results: A total of 1,886 records were screened, of which 18 were included in the final review. In total, 37 risk factors were identified in the systematic review. Meta- analysis showed that age, type of CHD, cardiac reoperation, biventricular shunt before operation, CPB duration, ACC duration, postoperative residual shunt, cTn-1 level 2 h after CPB > 14 ng/ml and postoperative 24 h MR-ProADM level > 1.5 nmol/l were independent risk factors of LCOS. Additionally, the level of blood oxygen saturation before the operation was found to have no statistically significant relationship with LOCS.

Conclusion: The risk factors of postoperative LCOS in children with CHD are related to disease condition, intraoperative time and postoperative related indexes, so early prevention should be aimed at high-risk children.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022323043.

Keywords: children; congenital heart disease; low cardiac output syndrome; meta-analysis; risk factors; systematic review.

Publication types

Review