Key result
Novel nomogram predicts postoperative MACE in neonates following critical congenital heart disease surgery with AUC ~0.86.
Why the study?
Major adverse cardiovascular events remain common after neonatal surgery for critical congenital heart disease, prompting the need to identify independent risk factors and develop a predictive nomogram for individualized risk assessment.
Cohort (n=302)
No
A newly developed nomogram incorporating seven perioperative variables accurately predicts the risk of major adverse cardiovascular events in neonates undergoing surgery for critical congenital heart disease.
Answers are grounded in this paper and cite their sources.
May aid perioperative risk stratification in neonates; hypothesis-generating pending prospective validation.
Background Major adverse cardiovascular events (MACE) remain common after surgery in neonates with critical congenital heart disease (CCHD). We aimed to identify the incidence and independent risk factors for postoperative MACE and develop a predictive nomogram for individualized risk assessment. Methods This retrospective cohort included neonates undergoing cardiopulmonary bypass surgery for CCHD at Beijing Anzhen Hospital from January 2018 to December 2024. MACE was defined as a composite of mortality, cardiopulmonary resuscitation, unplanned reoperation, and extracorporeal membrane oxygenation (ECMO) support. Univariate and multivariable logistic regression analyses, together with least absolute shrinkage and selection operator (LASSO) regression, were used to identify independent predictors and to construct a nomogram. Model performance was evaluated by discrimination, calibration, and clinical utility. Results Among 302 neonates, 48 (15.89%) experienced postoperative MACE, including mortality (8.61%), cardiopulmonary resuscitation (9.60%), unplanned reoperations (8.94%), and ECMO (3.31%). Multivariable logistic regression identified low birth weight (< 2.5 kg; OR = 5.728, 95% CI 2.130–15.496), emergent surgery (OR = 3.996, 95% CI 1.458–10.878), prolonged aortic cross-clamp time (OR = 1.021, 95% CI 1.003–1.040), repeated aortic cross-clamping (OR = 5.464, 95% CI 1.002–28.377), elevated maximum vasoactive-inotropic score within 24 h postoperatively (OR = 1.050, 95% CI 1.012–1.091), and elevated lactate at surgery completion (OR = 1.180, 95% CI 1.065–1.339) as independent risk factors for MACE, whereas prenatal diagnosis was protective (OR = 0.316, 95% CI 0.136–0.732). The nomogram demonstrated excellent performance (C-index: 0.839, AUC: 0.859) and good calibration. Conclusions In neonates with CCHD, independent risk factors for postoperative MACE included low birth weight, emergency surgery, prolonged or repeated ACC, elevated maximum VIS within 24 h postoperatively, and elevated lactate at surgery completion, whereas prenatal diagnosis was protective. The nomogram accurately predicts perioperative MACE in CCHD neonates, aiding individualized risk assessment and management.
No takes yet. Share an insight, caveat, or question.
Sun et al. (2026) conducted a cohort in Neonates (≤28 days) with critical congenital heart disease undergoing cardiopulmonary bypass surgery (n=302). Nomogram prediction model for postoperative major adverse cardiovascular events vs. No predictive nomogram was evaluated on Incidence of postoperative major adverse cardiovascular events (MACE), defined as composite of mortality, cardiopulmonary resuscitation, unplanned reoperation, and extracorporeal membrane oxygenation support. The developed nomogram predicted postoperative major adverse cardiovascular events with excellent discrimination (C-index 0.839, AUC 0.859) in neonates undergoing surgery for critical congenital heart disease, where 15.89% experienced MACE including 8.61% mortality.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: