Nomogram for Postoperative Permanent Neurologic Dysfunction Following Acute Type A Aortic Dissection Surgery: A Multicentral Retrospective Study
Related Experiment Videos
Jian Chen1, Jianan Li1, Juncheng Yu1
1Department of Cardiac Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Background:
Permanent neurologic dysfunction (PND) often complicates following surgery for acute type A aortic dissection (ATAAD) and is strongly correlated with unfavorable outcomes. Consequently, developing an effective diagnostic method to identify high-risk patients is of considerable importance.
Methods:
This retrospective study, covering 2022 to 2024 across two centers, ultimately included 117 ATAAD patients with Supra-Aortic Branch Vessel (SABV) dissection from our center (2022-2023) as the training set and 52 ATAAD patients with SABV dissection from a secondary center (2024) as the validation set. We used logistic regression to identify predictors and developed a nomogram, which was assessed using the area under the ROC curve, calibration and decision curve analysis. External validation was conducted using the validation set.
Results:
In this study, 169 cases were finally collected (117 in the training set and 52 in the validation set), of whom 64 patients developed postoperative PND. Four risk factors were identified: brachiocephalic trunk dissection at the bifurcation plane, chronic kidney disease, age over 50, and cross-clamp duration over 168 min. The AUC was 0.809 for the training set and 0.736 for the validation set. The nomogram model demonstrated acceptable predictive performance, and decision curve analysis potential clinical utility for predicting postoperative PND risk for thresholds of 1%-90% in the training set and 3%-75% in the validation set.
Conclusions:
This study developed and validated a predictive model for assessing the risk of postoperative PND in patients undergoing ATAAD surgery, which may assist clinicians in individualized risk assessment.
