Key result
Novel nomogram predicts early postoperative cerebral desaturation events with a ~0.80 C-statistic.
Why the study?
Infants undergoing congenital heart surgery with CPB face high risk of neurological injury and early postoperative cerebral desaturation events, but reliable individualized risk stratification tools are lacking.
Cohort (n=397)
No
A novel, internally validated nomogram incorporating routine perioperative variables can reliably predict early postoperative cerebral desaturation events in infants undergoing congenital heart surgery with cardiopulmonary bypass.
May support targeted CDE risk stratification after infant CPB surgery; leaves open clinical use pending external prospective validation.
Background Infants 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. Methods This 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. Results Early 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. Conclusions An 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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Wang et al. (2026) conducted a cohort in Congenital heart disease (n=397). A novel nomogram incorporating body surface area, RACHS-1 category, CPB duration, hematocrit, and temperature strategy predicted early postoperative cerebral desaturation events with a C-statistic of 0.798.
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