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Nuclear Cell-Free DNA Predicts Adverse Events After Pediatric Cardiothoracic Surgery.

Justinn M Tanem1, John P Scott1, George M Hoffman1

  • 1Division of Pediatric Anesthesiology, Department of Anesthesiology, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin.

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Elevated nuclear cell-free DNA (ncfDNA) before pediatric heart surgery predicts poor outcomes. This biomarker may help identify children at high risk for cardiac arrest or need for ECMO after surgery.

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Area of Science:

  • Cardiology
  • Biomarkers
  • Pediatric Surgery

Background:

  • Cardiac surgery risk stratification uses patient and procedure factors.
  • Unidentified factors contribute to outcome variations.
  • Nuclear cell-free DNA (ncfDNA) indicates tissue injury.

Purpose of the Study:

  • Measure ncfDNA kinetics in children undergoing heart operations with cardiopulmonary bypass (CPB).
  • Link biomarkers, organ dysfunction, and outcomes.
  • Identify latent physiologic risk factors to improve predictive models.

Main Methods:

  • Prospective observational study of 116 children (<18 years, >3 kg) undergoing CPB.
  • Plasma ncfDNA samples collected at perioperative time points.
  • Primary outcome: postoperative cardiac arrest or extracorporeal membrane oxygenation (ECMO).

Main Results:

  • Elevated preoperative ncfDNA (>20 ng/mL) associated with 25-fold increased risk of primary outcome (P = .001).
  • Risk of primary outcome was 33% with elevated ncfDNA vs. 2% with normal levels.
  • Higher ncfDNA levels correlated with fewer hospital-free days (P < .01).

Conclusions:

  • Preoperative ncfDNA is strongly associated with postoperative arrest and ECMO in pediatric cardiac surgery.
  • ncfDNA kinetics may serve as a predictive tool for morbidity.
  • Further validation is needed for clinical application in pediatric cardiac surgical procedures.