Background
Methods
Study design and population
Outcomes
Risk factors
Statistical analysis
Results
Demographic characteristics of CHD children
Parameter | LCOS (n = 864) | non-LCOS (n = 7796) | Total (n = 8660) | P value | |
---|---|---|---|---|---|
Demographic characteristics | |||||
Age (days) | Median (IQR) | 206.5 (94,507.5) | 350 (182, 950.5) | 329 (173, 916) | < 0.001 |
Gender | MALE | 56.4% | 55.0% | 55.1% | 0.4 |
FEMALE | 43.6% | 45.1% | 44.9% | ||
BMI | <5th percentile | 23.4% | 19.0% | 19.5% | 0.016 |
5th~95th percentile | 62.8% | 66.7% | 66.3% | ||
>95th percentile | 13.8% | 14.3% | 14.2% | ||
Pre-operative color doppler echocardiography characteristics | |||||
Aortic shunt | None | 76.1% | 90.4% | 89.0% | < 0.001 |
Left-to-right | 15.3% | 7.7% | 8.4% | ||
Right-to-left | 0.7% | 0.03% | 0.1% | ||
Bi-directional | 8.0% | 1.9% | 2.5% | ||
Atrial shunt | None | 21.7% | 36.5% | 35.1% | < 0.001 |
Left-to-right | 39.6% | 47.8% | 47.0% | ||
Right-to-left | 6.9% | 2.7% | 3.1% | ||
Bi-directional | 31.8% | 13.0% | 14.9% | ||
Ventricular level shunt | None | 23.7% | 28.6% | 28.1% | < 0.001 |
Left-to-right | 12.3% | 40% | 37.3% | ||
Right-to-left | 0.3% | 0.1% | 0.1% | ||
Bi-directional | 63.8% | 31.3% | 34.5% | ||
AI | Negative | 80.0% | 83.1% | 82.8% | 0.035 |
Minimal | 13.6% | 10.8% | 11.0% | ||
Mild | 5.2% | 5.2% | 5.2% | ||
Mild-to-moderate | 0.3% | 0.5% | 0.4% | ||
Moderate | 0.4% | 0.3% | 0.3% | ||
Moderate-to-severe | 0.1% | 0.1% | 0.1% | ||
Severe | 0.5% | 0.1% | 0.1% | ||
MR | Negative | 26.6% | 22.6% | 23.0% | 0.9 |
Minimal | 43.0% | 49.0% | 48.4% | ||
Mild | 18.5% | 20.5% | 20.3% | ||
Mild-to-moderate | 6.1% | 4.5% | 4.6% | ||
Moderate | 3.3% | 2.3% | 2.4% | ||
Moderate-to-severe | 1.7% | 0.7% | 0.8% | ||
Severe | 0.8% | 0.4% | 0.4% | ||
PI | Negative | 16.3% | 9.2% | 9.9% | 0.007 |
Minimal | 53.1% | 59.5% | 58.9% | ||
Mild | 28.8% | 29.6% | 29.6% | ||
Mild-to-moderate | 0.7% | 0.6% | 0.6% | ||
Moderate | 1.1% | 1.0% | 1.0% | ||
Moderate-to-severe | 0% | 0.03% | 0.03% | ||
Severe | 0% | 0.04% | 0.04% | ||
TR | Negative | 1.2% | 0.4% | 0.5% | 0.001 |
Minimal | 42.8% | 47.4% | 46.9% | ||
Mild | 40.3% | 43.3% | 43% | ||
Mild-to-moderate | 8.5% | 5.6% | 5.8% | ||
Moderate | 4.4% | 2.4% | 2.6% | ||
Moderate-to-severe | 2.0% | 0.4% | 0.6% | ||
Severe | 0.8% | 0.5% | 0.6% | ||
LVEF | < cut off value | 56.3% | 55.4% | 55.5% | 0.7 |
Normal | 27.3% | 28.7% | 28.5% | ||
> cut off value | 16.5% | 15.9% | 16% | ||
LVFS | < cut off value | 56.9% | 54.2% | 54.4% | 0.1 |
Normal | 27.5% | 30.9% | 30.6% | ||
> cut off value | 15.6% | 14.9% | 15.0% | ||
Mitral insufficiency | NO | 92.0% | 93.8% | 93.6% | 0.044 |
YES | 8.0% | 6.2% | 6.4% | ||
Mitral Stenosis | NO | 99.0% | 99.4% | 99.4% | 0.1 |
YES | 1.0% | 0.6% | 0.6% | ||
The characteristic of surgery and cardiopulmonary bypass | |||||
History of heart surgery | NO | 84.6% | 92.3% | 91.5% | < 0.001 |
YES | 15.4% | 7.7% | 8.5% | ||
RACHS-1 risk grade | 1 | 6.0% | 13.9% | 13.1% | < 0.001 |
2 | 50.1% | 62.8% | 61.6% | ||
3 | 32.4% | 20.9% | 22.1% | ||
4 | 10.3% | 2.2% | 3.0% | ||
5 | 1.2% | 0.1% | 0.2% | ||
6 | 0% | 0.1% | 0.1% | ||
CPB duration (min) | Median (IQR) | 87 (62,119) | 51 (38,72) | 53 (39,78) | < 0.001 |
Aortic clamping time (min) | Median (IQR) | 53 (37,74) | 29 (20,44) | 31 (21,48) | < 0.001 |
Operation characteristics | Selective extracorporeal surgery | 92.8% | 98.6% | 98% | < 0.001 |
Emergency non-extracorporeal surgery | 0.1% | 0.01% | 0.02% | ||
Emergency extracorporeal surgery | 7.1% | 1.2% | 1.8% | ||
Selective non-extracorporeal surgery | 0% | 0.1% | 0.1% | ||
Elective thoracotomy | 0% | 0.1% | 0.1% | ||
Circulating temperature | Normal temperature | 21.8% | 53.1% | 49.9% | < 0.001 |
Mild hypothermia | 52.0% | 38.7% | 40.1% | ||
Deep hypothermia | 2.2% | 0.6% | 0.7% | ||
Middle and low temperature | 24.1% | 7.6% | 9.3% | ||
Circulation method | Low flow cycle | 0.7% | 0.1% | 0.1% | < 0.001 |
Cerebral perfusion | 5.3% | 1.5% | 1.9% | ||
Parallel CPB | 3.0% | 3.4% | 3.3% | ||
Full flow | 89.9% | 94.6% | 94.2% | ||
Circulatory arrest | 0.9% | 0.4% | 0.4% | ||
Cerebrovascular perfusion | 0.1% | 0.1% | 0.1% | ||
Difficult to wean from CPB | NO | 99.7% | 99.9% | 99.9% | 0.1 |
YES | 0.4% | 0.1% | 0.1% | ||
Myocardial preservation | HTK | 31.6% | 8.9% | 11.2% | < 0.001 |
Cold blood cardioplegia (4:1) | 68.4% | 91.1% | 88.8% | ||
Post-operative characteristic | |||||
Residual shunt | NO | 98.4% | 99.6% | 99.5% | < 0.001 |
YES | 1.62%) | 0.4% | 0.5% | ||
LVOTO | NO | 98.3% | 99.5% | 99.4% | < 0.001 |
YES | 1.7% | 0.5% | 0.6% | ||
RVOTO | NO | 98.4% | 99.7% | 99.6% | < 0.001 |
YES | 1.6% | 0.3% | 0.4% | ||
Postoperative rhythm of the heart | III°AVB | 1.2% | 0.1% | 0.2% | < 0.001 |
II°AVB | 0.6% | 0.2% | 0.2% | ||
Atrioventricular dissociation | 0.2% | 0.1% | 0.1% | ||
Supraventricular tachycardia | 0.2% | 0.1% | 0.1% | ||
Sinus rhythm | 97.8% | 99.5% | 99.3% |
Preoperative Doppler echocardiography characteristics of CHD children
Characteristics of surgery and cardiopulmonary bypass of CHD children
Postoperative measures of CHD children
Logistic regression analysis
Univariate analysis | Multivariate analysis | ||||
---|---|---|---|---|---|
Parameter | OR (95% CI) | P-value | OR (95% CI) | Pvalue | |
Age (days) | 0.992 (0.989,0.995) | < 0.001 | 0.992 (0.988,0.997) | 0.001 | |
Gender | Male vs Female | 1.06 (0.92,1.22) | 0.4 | ||
AI | 1.118 (1.008,1.239) | 0.034 | |||
MR | 1.06 (0.99,1.14) | 0.1 | |||
PI | 0.845 (0.751,0.951) | 0.005 | |||
TR | 1.226 (1.13,1.33) | < 0.001 | 1.192 (1.072,1.326) | 0.001 | |
RACHS-1 risk grade | 2.094 (1.903,2.304) | < 0.001 | 1.166 (1.011,1.345) | 0.035 | |
Aortic shunt | Left-to-right vs None | 2.363 (1.904,2.932) | < 0.001 | 1.37 (1.005,1.867) | 0.046 |
Right-to-left vs None | 27.469 (5.318,141.869) | < 0.001 | |||
Bi-directional vs None | 5.087 (3.721,6.953) | < 0.001 | 1.716 (1.138,2.587) | 0.01 | |
Atrial shunt | Left-to-right vs None | 1.396 (1.151,1.693) | 0.001 | 1.407 (1.097,1.805) | 0.007 |
Right-to-left vs None | 4.412 (3.149,6.18) | < 0.001 | 3.168 (1.944,5.163) | < 0.001 | |
Bi-directional vs None | 4.111 (3.34,5.059) | < 0.001 | 1.87 (1.389,2.519) | < 0.001 | |
Ventricular level shunt | Left-to-right vs None | 0.37 (0.288,0.476) | < 0.001 | 0.676 (0.486,0.94) | 0.02 |
Right-to-left vs None | 3.16 (0.65,15.32) | 0.2 | 3.458 (0.452,26.448) | 0.2 | |
Bi-directional vs None | 2.452 (2.052,2.93) | < 0.001 | 2.09 (1.611,2.712) | < 0.001 | |
Operation characteristics | Emergency non-extracorporeal surgery vs Selective extracorporeal surgery | 9.58 (0.6153.34) | 0.1 | ||
Emergency extracorporeal surgery vs Selective extracorporeal surgery | 6.153 (4.425,8.556) | < 0.001 | |||
Selective non-extracorporeal surgery vs Selective extracorporeal surgery | 0 (0,1.053157E255) | 0.97 | |||
Elective thoracotomy vs Selective extracorporeal surgery | 0 (0) | 0.98 | |||
History of heart surgery | YES vs NO | 2.17 (1.772,2.658) | < 0.001 | ||
Residual shunt | YES vs NO | 4.264 (2.252,8.073) | < 0.001 | 3.489 (1.502,8.105) | 0.004 |
LVOTO | YES vs NO | 3.81 (2.078,6.988) | < 0.001 | 3.934 (1.673,9.254) | 0.002 |
RVOTO | YES vs NO | 5.82 (2.967,11.418) | < 0.001 | 3.638 (1.225,10.798) | 0.02 |
Circulating temperature | Mild hypothermia vs Normal temperature | 3.271 (2.741,3.903) | < 0.001 | 1.526 (1.205,1.934) | < 0.001 |
Deep hypothermia vs Normal temperature | 9.289 (5.328,16.194) | < 0.001 | 1.369 (0.587,3.194) | 0.467 | |
Middle and low temperature vs Normal temperature | 7.691 (6.202,9.537) | < 0.001 | 1.738 (1.236,2.443) | 0.001 | |
Circulation method | Low flow vs Full flow | 11.395 (3.47,37.422) | < 0.001 | ||
Cerebral perfusion vs Full flow | 3.671 (2.591,5.199) | < 0.001 | |||
Parallel CPB vs Full flow | 0.94 (0.63,1.42) | 0.8 | |||
Circulatory arrest vs Full flow | 2.813 (1.274,6.214) | 0.011 | |||
Cardio-cerebral Perfusion vs Full flow | 1.90 (0.22,16.28) | 0.6 | |||
CPB duration (min) | 1.016 (1.014,1.017) | < 0.001 | 1.009 (1.006,1.012) | < 0.001 | |
Aortic clamping time (min) | 1.026 (1.023,1.028) | < 0.001 | |||
Postoperative rhythm of the heart | III°AVB vs Sinus rhythm | 9.181 (3.81,22.121) | < 0.001 | ||
II°AVB vs Sinus rhythm | 2.869 (1.048,7.851) | 0.04 | |||
Atrioventricular dissociation vs Sinus rhythm | 2.30 (0.49,10.83) | 0.3 | |||
Supraventricular tachycardia vs Sinus rhythm | 4.59 (0.84,25.1) | 0.1 | |||
Difficult to wean from CPB | YES vs NO | 4.524 (1.129,18.121) | 0.033 | ||
Myocardial preservation | HTK vs Cold blood cardioplegia (4:1) | 4.744 (4.014,5.607) | < 0.001 | 1.677 (1.298,2.167) | < 0.001 |
BMI | <5th percentile vs 5th~5th percentile | 1.305 (1.086,1.569) | 0.004 | ||
>95th percentile vs 5th~5th percentile | 1.03 (0.82,1.28) | 0.8 | |||
LVEF | < cut off value vs Normal | 1.07 (0.90,1.27) | 0.4 | ||
> cut off value vs Normal | 1.09 (0.87,1.37) | 0.5 | |||
LVFS | < cut off value vs Normal | 1.18 (1.00,1.4) | 0.1 | ||
> cut off value vs Normal | 1.18 (0.93,1.48) | 0.2 | |||
Mitral insufficiency | YES vs NO | 1.309 (1.006,1.702) | 0.045 | 1.714 (1.239,2.37) | 0.001 |
Mitral stenosis | YES vs NO | 1.77 (0.87,3.64) | 0.1 |
Postoperative mortality, prolonged ICU stay, and extended medical ventilator support in LCOS and non-LCOS CHD children
Parameter | LCOS (n = 864) | Non- LCOS (n = 7796) | Total (n = 8660) | P value | |
---|---|---|---|---|---|
Mortality (%) | NO | 92.8% | 98.9% | 98.3% | < 0.001 |
YES | 7.2% | 1.1% | 1.7% | ||
Length of ICU stay | <=3d | 10.8% | 66.7% | 61.1% | < 0.001 |
> 3d | 89.2% | 33.4% | 38.9% | ||
Duration of Medical ventilator | <=48 h | 6.8% | 55.5% | 50.7% | < 0.001 |
> 48 h | 93.2% | 44.5% | 49.3% |
Incidence of postoperative LCOS in children with CHD of different nutritional status
Age | BMI < 5th percentile | BMI 5th~95th percentile | BMI > 95th percentile |
---|---|---|---|
< 1 month | 41.2% | 39.4% | 35.7% |
1 month~ 3 month | 17.9% | 26.1% | 17.9% |
3 month~ 6 month | 21.4% | 12.5% | 9.1% |
6 month~ 1 year | 11.5% | 9.3% | 5.1% |
1 year~ 3 year | 10.2% | 4.4% | 4.2% |
> 3 year | 12.6% | 7.8% | 3.1% |