Risk Prediction Model for Major Adverse Outcome in Proximal Thoracic Aortic Surgery.

Area of Science:

• Cardiovascular Surgery
• Thoracic Aortic Surgery
• Medical Risk Prediction

Background:

• Proximal thoracic aortic surgery with hypothermic circulatory arrest carries significant risks.
• Patient risk varies, necessitating individualized assessment.
• Degenerative pathology is a common indication for this procedure.

Purpose of the Study:

• To develop a risk prediction model for patients undergoing proximal thoracic aortic surgery with hypothermic circulatory arrest.
• To stratify patient risk for degenerative aortic pathology.
• To improve preoperative physician-patient counseling.

Main Methods:

• Retrospective analysis of 489 patients undergoing proximal thoracic aortic surgery with hypothermic circulatory arrest for degenerative pathology.
• Exclusion of patients with acute dissection.
• Multivariable logistic regression to identify predictors of major adverse outcome (30-day mortality, stroke, renal failure, prolonged ventilation, non-home discharge).
• External validation using an independent cohort of 120 patients.

Main Results:

• Age, total arch replacement, and procedure urgency (urgent/emergent) were identified as independent predictors of major adverse outcome.
• The model demonstrated excellent calibration and a concordance index of 0.93 in external validation.
• Odds ratios for predictors were: Age (2.01), Total Arch Replacement (6.75), Urgent Procedure (2.73), Emergent Procedure (43.58).

Conclusions:

• Identified key risk factors for major adverse outcomes in proximal thoracic aortic surgery with hypothermic circulatory arrest.
• A simple and accurate risk prediction model was developed.
• The model facilitates objective risk quantification for preoperative counseling in degenerative aortic pathology.