Predictors of Low Cardiac Output Syndrome in Infants After Open-Heart Surgery.

Liang Zou,Yueshuang Cun,Qingfeng Wang,Yaping Li,Xuming Mo,Ruonan Wang,Yaqin Shu,Di Yu

doi:10.3389/fped.2022.829731

Abstract

ObjectiveTo evaluate the predictors of low cardiac output syndrome (LCOS) in infants with congenital heart disease (CHD) after cardiopulmonary bypass (CPB).Study designA total of 217 infants were enrolled and classified according to whether they developed LCOS after cardiac surgery. Each infant's preoperative and intraoperative clinical variables were collected.ResultsThe incidence of LCOS was 28.11% in our study. The univariate analysis showed that the LCOS group was younger than the non-LCOS group (25.69 ± 25.01 days vs. 44.45 ± 26.97 days, P < 0.001), with a higher proportion of neonates (60.7 vs. 27.6%, P < 0.001) and a higher proportion of patients with a RACHS-1 score ≥4 (50.8 vs. 17.9%, P < 0.001). A lower weight (3.70 ± 0.74 vs. 4.23 ± 1.10 kg, P = 0.001), longer ACC time (61.96 ± 21.44 min vs. 41.06 ± 18.37 min, P < 0.001) and longer CPB time (131.54 ± 67.21 min vs. 95.78 ± 62.67 min, P < 0.001) were found in the LCOS group. The levels of free triiodothyronine (FT3) (4.55 ± 1.29 pmol/L vs. 5.18 ± 1.42 pmol/L, P = 0.003) and total triiodothyronine (TT3) (1.80 ± 0.56 nmol/L vs. 1.98 ± 0.54 nmol/L, P = 0.026) were also lower in the LCOS group. The multivariate binary logistic regression analysis and receiver operating characteristic (ROC) indicated that the ACC time, FT3 level and body weight were independent predictors of LCOS.ConclusionsIn our patient population, we first propose that preoperative FT3 can predict the occurrence of postoperative LCOS. ACC time, FT3 level and body weight are independent predictors of LCOS and maybe helpful in reducing the incidence of postoperative LCOS in the future.

Highlights

Low cardiac output syndrome (LCOS) is a common, well-recognized collection of physiological and hemodynamic disturbances indicating the inability of the heart to deliver sufficient oxygen to tissue and end organs to meet metabolic demand
We conducted a retrospective study to identify the predictors of postoperative LCOS in infants under 3 months undergoing congenital heart defects (CHDs) surgery with cardiopulmonary bypass (CPB)
We found that the preoperative FT3 level, body weight and ACC time may outperform other clinical parameters in predicting the incidence of postoperative LCOS in infants less than 3 months old undergoing CHD surgery with CPB

Summary

Introduction

Low cardiac output syndrome (LCOS) is a common, well-recognized collection of physiological and hemodynamic disturbances indicating the inability of the heart to deliver sufficient oxygen to tissue and end organs to meet metabolic demand. LCOS was first reported by Parr et al [1] and typically occurs in 25% to 65% of children with congenital heart defects (CHDs) 6–8 h after cardiopulmonary bypass (CPB) [2]. Du et al found that the CPB temperature, myocardial protection with histidinetryptophan-ketoglutarate, and postoperative application of a residual shunt were independent risk predictors of LCOS in children older than 3 months [4]. A small number of cytokines, such as the preoperative neutrophil-lymphocyte ratio, postoperative mid-regional pro-adrenomedullin (MR-proADM) and postoperative cardiac troponin I (cTn-I), have been reported as risk factors in children who presented with LCOS after cardiac surgery [5, 6]. The risk predictors of LCOS in infants following CHD surgery under CPB are still uncertain. We conducted a retrospective study to identify the predictors of postoperative LCOS in infants under 3 months undergoing CHD surgery with CPB

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Conclusion