Year-end Sale % OFF 
Abstract
Background: Postoperative adverse events remain excessively high in surgical patients with coarctation of aorta (CoA). Currently, there is no generally accepted strategy to predict these patients' individual outcomes.Objective: This study aimed to develop a risk model for the prediction of postoperative risk in pediatric patients with CoA.Methods: In total, 514 patients with CoA at two centers were enrolled. Using daily clinical practice data, we developed a model to predict 30-day or in-hospital adverse events after the operation. The least absolute shrinkage and selection operator approach was applied to select predictor variables and logistic regression was used to develop the model. Model performance was estimated using the receiver-operating characteristic curve, the Hosmer–Lemeshow test and the calibration plot. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) compared with existing risk strategies were assessed.Results: Postoperative adverse events occurred in 195 (37.9%) patients in the overall population. Nine predictive variables were identified, including incision of left thoracotomy, preoperative ventilation, concomitant ventricular septal defect, preoperative cardiac dysfunction, severe pulmonary hypertension, height, weight-for-age z-score, left ventricular ejection fraction and left ventricular posterior wall thickness. A multivariable logistic model [area under the curve = 0.8195 (95% CI: 0.7514–0.8876)] with adequate calibration was developed. Model performance was significantly improved compared with the existing Aristotle Basic Complexity (ABC) score (NRI = 47.3%, IDI = 11.5%) and the Risk Adjustment for Congenital Heart Surgery (RACHS-1) (NRI = 75.0%, IDI = 14.9%) in the validation set.Conclusion: Using daily clinical variables, we generated and validated an easy-to-apply postoperative risk model for patients with CoA. This model exhibited a remarkable improvement over the ABC score and the RACHS-1 method.
Highlights
Coarctation of aorta (CoA), which accounts for 6–8% of congenital heart disease (CHD), is a common disease with an incidence of about 1 in 2,500 live births [1,2,3]
The data used to develop and validate the model came from the multi-center registration study of Prognosis and Integrative Assessment of Aortic Coarctation Patients in China (PICC) (ClinicalTrials.gov ID: NCT 04011956), and data on children undergoing CoA correction were retrospectively collected in the two centers: Center 1 (Beijing Anzhen Hospital, Beijing, China) from January 2002 to July 2020 and Center 2
There were a total of 514 patients with CoA correction enrolled in PICC study as of July 2020 in Center 1 (n = 360) and Center 2 (n = 154) (Supplementary Figure 2)
Summary
Coarctation of aorta (CoA), which accounts for 6–8% of congenital heart disease (CHD), is a common disease with an incidence of about 1 in 2,500 live births [1,2,3]. Contemporary risk strategies for CHD mainly include the Aristotle Basic Complexity (ABC) score and the Risk Adjustment for Congenital Heart Surgery (RACHS-1), the Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) mortality score and category, the STAT morbidity score and category. Such risk tools were developed on the basis of expert opinions or procedural complexity at the population-level, and focus primarily on inhospital mortality or morbidity [6,7,8,9,10]. There is no generally accepted strategy to predict these patients’ individual outcomes
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
