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.
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。