Retrospective cohort study links congenital heart surgery with CPB to early postoperative cerebral desaturation events in infants.
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Key Takeaway
Note that external validation is required before clinical implementation of this CDE prediction model.
This retrospective cohort study included 397 infants aged >1 month and ≤1 year undergoing elective congenital heart surgery with cardiopulmonary bypass in a cardiac intensive care unit setting. The primary outcome was early postoperative cerebral desaturation events (CDEs). The incidence of CDEs was 16.88% overall, with 18.1% in the development cohort and 14.2% in the validation cohort. No specific adverse events, discontinuations, or tolerability data were reported.
A predictive model demonstrated discrimination with a C-statistic of 0.798 (95% CI 0.729–0.857) in the development cohort and 0.767 (95% CI 0.629–0.886) in the validation cohort. Decision curve analysis suggested potential clinical usefulness across clinically relevant threshold probabilities. However, the study notes that external validation is required before clinical implementation.
Limitations include the retrospective design, lack of reported adverse events, and reliance on internal validation only. As an association study, causality cannot be inferred. These findings highlight the need for further prospective validation before integrating the model into routine practice for this specific population.
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View Original Abstract ↓
BackgroundInfants undergoing congenital heart surgery with cardiopulmonary bypass (CPB) are at high risk for perioperative neurological injury, and early postoperative cerebral desaturation events (CDEs) remain common. Reliable tools for individualized risk stratification are lacking. This study aims to develop and internally validate a nomogram for predicting early postoperative CDEs in infants undergoing congenital heart surgery with CPB.MethodsThis retrospective cohort study included 397 infants aged >1 month and ≤1 year who underwent elective congenital heart surgery with CPB. Patients were randomly divided into a development cohort (n = 277) and a validation cohort (n = 120). Early postoperative CDEs were assessed using near-infrared spectroscopy monitoring at cardiac intensive care unit admission. Prespecified perioperative variables measured before or during CPB were entered into a multivariable logistic regression model to construct a nomogram. Model performance was evaluated using discrimination, calibration, and decision curve analysis, with internal validation.ResultsEarly postoperative CDEs occurred in 16.88% of the overall cohort, with comparable incidences in the development (18.1%) and validation (14.2%) cohorts. The final model included body surface area, RACHS-1 category, CPB duration, hematocrit during CPB, and CPB temperature strategy. The nomogram demonstrated good discrimination in the development cohort [C-statistic 0.798, 95% confidence interval (CI) 0.729–0.857] and the validation cohort (0.767, 95% CI 0.629–0.886), with satisfactory calibration. The decision curve analysis suggested potential clinical usefulness across clinically relevant threshold probabilities.ConclusionsAn internally validated, infant-specific nomogram based on routinely available perioperative variables was developed to predict early postoperative cerebral desaturation following congenital heart surgery with CPB. External validation is required before clinical implementation.
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