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Table 1 The clinical characteristics of CHD children (including demographic characteristics, pre-operative color doppler echocardiography characteristics, the characteristic of surgery and cardiopulmonary bypass, and post-operative characteristics)

From: Risk factors for low cardiac output syndrome in children with congenital heart disease undergoing cardiac surgery: a retrospective cohort study

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%

 
  1. Abbreviation: CHD Congenital Heart Disease, LCOS Low Cardiac Output Syndrome, BMI Body Mass Index, AI Aortic Insufficiency, MR Mitral Regurgitation, PI Pulmonary Insufficiency, TR Tricuspid Regurgitation, LVEF Left Ventricular Ejection Fraction, LVFS left ventricular fraction shortening, CPB Cardiopulmonary Bypass, LVOTO Left Ventricular Outflow Tract Obstruction, RVOTO Right Ventricular Outflow Tract Obstruction, HTK histidine-tryptophan-ketoglutarate, AVB atrioventricular block