Anisocytosis as a possible predictor of low cardiac output syndrome in children undergoing mitral valve surgery

Michał Sobieraj; Tomasz Urbanowicz; Anna Olasińska-Wiśniewska; Marcin Gładki; Michał Michalak; Krzysztof J Filipiak; Anita Węclewska; Alicja Bartkowska-Śniatkowska; Andrzej Tykarski; Waldemar Bobkowski; Marek Jemielity

doi:10.1016/j.advms.2024.03.004

Anisocytosis as a possible predictor of low cardiac output syndrome in children undergoing mitral valve surgery

Adv Med Sci. 2024 Mar 16;69(1):147-152. doi: 10.1016/j.advms.2024.03.004. Online ahead of print.

Affiliations

¹ Pediatric Cardiac Surgery Department, Poznan University of Medical Sciences, Poznan, Poland.
² Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland. Electronic address: turbanowicz@ump.edu.pl.
³ Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland.
⁴ Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland.
⁵ Institute of Clinical Science, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland; Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
⁶ Pediatric Anaesthesiology and Intensive Therapy Department, Poznan University of Medical Sciences, Poznan, Poland.
⁷ Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
⁸ Pediatric Cardiology Department, Poznan University of Medical Sciences, Poznan, Poland.
⁹ Pediatric Cardiac Surgery Department, Poznan University of Medical Sciences, Poznan, Poland; Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland.

PMID: 38493878
DOI: 10.1016/j.advms.2024.03.004

Abstract

Purpose: Mitral valve surgery in children involves correcting congenital and acquired pathologies, with a reported mortality rate of 0.9%. Low cardiac output syndrome (LCOS) is a serious complication with the incidence of 20-25%. The aim of the study was to estimate possible prognostic factors of LCOS in children undergoing mitral valve procedure.

Material and method: This single-center retrospective analysis enrolled children aged <18 years who underwent mitral valve surgery during 24 year period. Preoperative clinical and laboratory parameters, and operative factors were analyzed.

Results: Thirty consecutive pediatric patients (11 (37%) males and 19 (63%) females) in median (Q₁ - Q₃) age of 57 (25-115) months, who underwent mitral valve replacement, were included. The 30-day mortality was 7% (2 patients) and was related to postoperative multiorgan failure. LCOS occurred in 8 (27%) children. The receiver operator curve (ROC) analysis established parameters that have predictive value for LCOS occurrence: cardiopulmonary bypass (CPB) time, with 89 min as optimal cut-off point (AUC = 0.744, p = 0.011) yielding sensitivity of 100% and specificity of 42.9%; left ventricular ejection fraction (LVEF) < 60 % (AUC = 0.824, okp = 0.001) with sensitivity of 62.5% and specificity of 93.75%; and red blood cell distribution width (RDW) above 14.5 % (AUC = 0.840, p < 0.001; sensitivity of 87.5% and specificity of 75%).

Conclusions: In mitral valve replacement in pediatric patients, CPBtime above 89 min, preoperative LVEF below 60% and preoperative RDW above 14.5% can be regarded as the potential predictors of LCOS.

Keywords: Anisocytosis; Low cardiac output syndrome; Mitral valve surgery.