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

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

Peiying Wang  1 , Cangcang Fu  2 , Guannan Bai  3 , Linbo Cuan  1 , Xiaomin Tang  1 , Chendi Jin  4 , Hongchong Jin  3 , Jihua Zhu  1 , Chunhong Xie  5
Affiliations
Review

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

Peiying Wang et al. Front Pediatr. .

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.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram for the selection of included articles.
Figure 2
Figure 2
Age of children in forest plot.
Figure 3
Figure 3
Types of congenital heart disease forest plot.
Figure 4
Figure 4
History of a cardiac surgery forest plot.
Figure 5
Figure 5
Preoperative oxygen saturation forest plot.
Figure 6
Figure 6
Biventricular shunt before operation forest plot.
Figure 7
Figure 7
Duration of CPB forest plot.
Figure 8
Figure 8
CPB duration forest plot.
Figure 9
Figure 9
ACC duration forest plot.
Figure 10
Figure 10
Postoperative residual shunt forest plot.
Figure 11
Figure 11
CTn-1 level 2 hours after CPB forest plot.
Figure 12
Figure 12
Postoperative 24h MR-ProADM level forest plot.
See this image and copyright information in PMC

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