Risk factors of postoperative low cardiac output syndrome in children with congenital heart disease: A systematic review and meta-analysis
Open accessAbstract
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.
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LCOS is the most common postoperative complication in children with CHD, with an incidence ranging between 25 and 60% and typically manifesting within the first 6 to 18 h following surgery.
“It is the most common postoperative complication in children with congenital heart disease (CHD), with an incidence ranging between 25 and 60% and typically manifesting within the first 6 to 18 h following surgery [3].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [3]
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- Authors
- Wang, P., Fu, C., Bai, G., Cuan, L., Tang, X., Jin, C., Jin, H., Zhu, J., & Xie, C.
- Affiliations
- Children's Hospital of Zhejiang University (CN)
- Corresponding author
- Zhu, Jihua
- Xie, Chunhong
- Venue
- Frontiers in Pediatrics
- Publisher
- Frontiers Media SA
- Published
- 2023-01-10
- Volume
- 10
- Pages
- 954427-954427
- ISSN
- 2296-2360 (ISSN-L)
- PMC
- PMC9871777
- OpenAlex
- W4315433942
- Cited by
- 20
- References
- 28
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 6 · 2023: 2
- FWCI
- 0.78
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Pediatrics (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
- Keywords
- low cardiac output syndrome, congenital heart disease, pediatric cardiac surgery, risk factors, cardiopulmonary bypass time, aortic cross-clamp time, cardiac reoperation, mid-regional pro-adrenomedullin, preoperative oxygen saturation
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