Aim
The incremental usefulness of circulating biomarkers from different pathological pathways for predicting mortality has not been evaluated in acute type A aortic dissection (ATAAD) patients. We aim to develop a risk prediction model and investigate the impact of arch repair strategy on mortality based on distinct risk stratifications.
Methods
A total of 3771 ATAAD patients who underwent aortic surgery retrospectively included were randomly divided into training and testing cohort at a ratio of 7:3 for the development and validation of risk model based on multiple circulating biomarkers and conventional clinical factors. Extreme gradient boosting was used to generate the risk models. Subgroup analysis were performed by risk stratifications (low versus middle-high risk) and arch repair strategies (proximal versus extensive arch repair).
Results
Addition of multiple biomarkers to a model with conventional factors fitted an ABC risk model consisted of platelet-leukocyte ratio, mean arterial pressure, albumin, age, creatinine, creatine kinase-MB, hemoglobin, lactate, left ventricular end-diastolic dimension, urea nitrogen, and aspartate aminotransferase, with adequate discrimination ability (AUROC 0.930 [95% CI 0.906-0.954] and 0.954 [95%CI 0.930-0.977] in the derivation and validation cohort, respectively). Compared with proximal arch repair, extensive repair was associated with similar mortality risk among patients at low risk (OR 1.838 [95%CI 0.559, 6.038]P = 0.316), but associated with higher mortality risk among patients at middle-high risk (OR 2.007 [95%CI 1.460, 2.757]P < 0.0001)
Conclusion
In ATAAD patients, simultaneous addition of circulating biomarkers of inflammatory, cardiac, hepatic, renal, and metabolic abnormalities substantially improved risk stratification and individualized arch repair strategy.
Background
Little is known regarding the effect of cardiopulmonary bypass (CPB) reoxygenation on cardiac function following tetralogy of Fallot repair. We hypothesized that hyperoxic reoxygenation would be more strongly associated with myocardial dysfunction in children with tetralogy of Fallot.
Methods
We investigated the association of perfusate oxygenation (PpO2) associated with myocardial dysfunction among children aged 6–72 months who underwent complete repair of tetralogy of Fallot in 2012–2018. Patients were divided into two groups: lower PpO2 group (≤ 250 mmHg) and higher PpO2 (> 250 mmHg) group based on the highest value of PpO2 during aortic occlusion. The odd ratio (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression models.
Results
This study included 163 patients perfused with lower PpO2 and 213 with higher PpO2, with median age at surgery 23.3 (interquartile range [IQR] 12.5–39.4) months, 164 female (43.6%), and median body mass index 15.59 (IQR 14.3–16.9) kg/m2. After adjustment for baseline, clinical and procedural variables, patients with higher PpO2 were associated with higher risk of myocardial dysfunction than those with lower PpO2 (OR 1.770; 95% CI 1.040–3.012, P = 0.035). Higher PpO2, lower SpO2, lower pulmonary annular Z-score, and longer CPB time were independent risk factors for myocardial dysfunction.
Conclusions
Association exists between higher PpO2 and myocardial dysfunction risk in patients with tetralogy of Fallot, highlighting the modulation of reoxygenation during aortic occlusion to reduce cardiovascular damage following tetralogy of Fallot repair.
Trial registration
Clinical Trials. gov number NCT03568357. June 26, 2018
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