The value of red blood cell distribution width in perioperative cardiac function assessment in children with congenital heart disease: A retrospective cohort study

Congenital heart disease (CHD) is the leading cause of birth defects in children, with high morbidity and mortality rates. Despite advances in surgical and interventional treatments, perioperative management of CHD remains challenging, particularly in complex cases and neonates. Effective perioperative assessment of cardiac function is essential for optimizing surgical outcomes and improving postoperative prognosis. This study investigates the association between red blood cell distribution width (RDW) and perioperative cardiac function in children with CHD. Specifically, we aim to determine whether RDW can serve as a reliable biomarker for assessing perioperative cardiac risk in this patient population. This retrospective cohort study included 107 pediatric patients aged 0 to 18 years who underwent surgical or interventional treatment for CHD at Sichuan Provincial Maternity and Child Health Hospital between March 2022 and March 2023. Patients were classified into 3 groups based on their cardiac function (Class I-III) according to the European Society of Cardiology guidelines. Clinical and imaging data, as well as RDW levels, were analyzed to assess their relationship with perioperative cardiac function. Both preoperative and postoperative RDW-coefficient of variation (RDW-CV) and RDW-standard deviation (RDW-SD) levels were significantly higher with increasing severity of cardiac dysfunction, with statistically significant differences observed among the 3 cardiac function groups (P < .001). Preoperative RDW-CV values were 13.26 ± 1.44%, 15.07 ± 2.13%, and 19.87 ± 3.62%, and RDW-SD values were 39.84 ± 4.04%, 45.02 ± 6.33%, and 56.12 ± 9.61% (all P < .001). Postoperative RDW-CV values were 14.05 ± 2.14%, 15.98 ± 2.29%, and 20.36 ± 4.42%, and RDW-SD values were 43.99 ± 4.73%, 48.21 ± 6.23%, and 58.33 ± 9.71% (all P < .001). Patients with heart failure had significantly higher RDW-CV and RDW-SD levels compared to non-heart failure patients, both preoperatively and postoperatively (P < .001). RDW is strongly associated with perioperative cardiac function in children with CHD. RDW levels increase with the severity of cardiac dysfunction and are clinically valuable in identifying heart failure in these children. As a simple and effective biomarker, RDW can assist in the perioperative assessment of cardiac function in this patient population.