Abstract：
OBJECTIVE: 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.
METHODS: 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.
METHODS: 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.
摘要：
目的：儿童二尖瓣手术涉及矫正先天性和获得性病变，报告死亡率为0.9%。低心输出量综合征（LCOS）是一种严重的并发症，发生率为20-25％。该研究的目的是评估接受二尖瓣手术的儿童LCOS的可能预后因素。
方法：此单中心回顾性分析纳入年龄<18岁、在24年期间接受二尖瓣手术的儿童。术前临床和实验室参数，并对手术因素进行分析。
结果：连续30名儿科患者（11名（37％）男性和19名（63％）女性），中位（Q1-Q3）年龄为57（25-115）个月，做了二尖瓣置换术,包括在内。30天死亡率为7％（2例），与术后多器官功能衰竭有关。8例（27%）儿童发生LCOS。受试者操作曲线（ROC）分析建立了对LCOS发生具有预测价值的参数：体外循环（CPB）时间，以89分钟为最佳临界点(AUC=0.744，p=0.011)，灵敏度为100%，特异性为42.9%；左心室射血分数(LVEF)<60%(AUC=0.824，okp=0.001)，灵敏度为62.5%，特异性为93.75%；红细胞分布宽度(RDW)高于14.5%(AUP=8840，特异性为0.75%)
结论：在小儿二尖瓣置换术中，CPB时间超过89分钟，术前LVEF低于60%和术前RDW高于14.5%可视为LCOS的潜在预测因子。
方法：此单中心回顾性分析纳入年龄<18岁、在24年期间接受二尖瓣手术的儿童。术前临床和实验室参数，并对手术因素进行分析。
结果：连续30名儿科患者（11名（37％）男性和19名（63％）女性），中位（Q1-Q3）年龄为57（25-115）个月，做了二尖瓣置换术,包括在内。30天死亡率为7％（2例），与术后多器官功能衰竭有关。8例（27%）儿童发生LCOS。受试者操作曲线（ROC）分析建立了对LCOS发生具有预测价值的参数：体外循环（CPB）时间，以89分钟为最佳临界点(AUC=0.744，p=0.011)，灵敏度为100%，特异性为42.9%；左心室射血分数(LVEF)<60%(AUC=0.824，okp=0.001)，灵敏度为62.5%，特异性为93.75%；红细胞分布宽度(RDW)高于14.5%(AUP=8840，特异性为0.75%)
结论：在小儿二尖瓣置换术中，CPB时间超过89分钟，术前LVEF低于60%和术前RDW高于14.5%可视为LCOS的潜在预测因子。
