TY - JOUR
T1 - Risk score for arch reconstruction under circulatory arrest with hypothermia
T2 - The ARCH score
AU - Canadian Thoracic Aortic Collaborative (CTAC)
AU - Guo, Ming Hao
AU - Stevens, Louis Mathieu
AU - Chu, Michael W.A.
AU - Hage, Ali
AU - Chung, Jennifer
AU - El-Hamamsy, Ismail
AU - Dagenais, Francois
AU - Peterson, Mark
AU - Herman, Christine
AU - Bozinovski, John
AU - Moon, Michael C.
AU - Yamashita, Michael H.
AU - Bittira, Bindu
AU - Payne, Darrin
AU - Boodhwani, Munir
AU - Ouzounian, Maral
AU - Chauvette, Vincent
AU - Cartier, Andreanne
AU - White, Abigail
AU - Lodewyks, Carly
AU - Atoui, Rony
N1 - Publisher Copyright:
© 2022
PY - 2024/2
Y1 - 2024/2
N2 - Objective: Currently, there is no risk scores built to predict risk in thoracic aortic surgery. This study aims to develop and internally validate a risk prediction score for patients who require arch reconstruction with hypothermic circulatory arrest. Methods: From 2002 to 2018, data for 2270 patients who underwent aortic arch surgery in 12 institutions in Canada were retrospectively collected. The outcomes modeled included in-hospital mortality and a modified Society of Thoracic Surgeons–defined composite for mortality or major morbidity. Multivariable logistic regression using least absolute shrinkage and selection operator selection method and mixed-effect regression model was used to select the predictors. Internal calibration of the final models is presented with an observed-versus-predicted plot. Results: There were 182 in-hospital deaths (8.0%), and the incidence of Society of Thoracic Surgeons-defined composite for mortality or major morbidity was 27.9%. Variables that increased risk of mortality are age, chronic obstructive pulmonary disease, atrial fibrillation, peripheral vascular disease, New York Heart Association class ≥III symptoms, acute aortic dissection or rupture, use of elephant trunk, concomitant surgery, and increased cardiopulmonary bypass time, with median c-statistics of 0.85 on internal validation. The c-statistics was 0.77 for the model predicting Society of Thoracic Surgeons–defined composite. Internal assessment shows good overall calibration for both models. Conclusions: We developed and internally validated a risk score for patients undergoing arch surgery requiring hypothermic circulatory arrest using a multicenter database. Once externally validated, the ARCH (Arch Reconstruction under Circulatory arrest with Hypothermia) score would allow for better patient risk-stratification and aid in the decision-making process for surgeons and patient prior to surgery.
AB - Objective: Currently, there is no risk scores built to predict risk in thoracic aortic surgery. This study aims to develop and internally validate a risk prediction score for patients who require arch reconstruction with hypothermic circulatory arrest. Methods: From 2002 to 2018, data for 2270 patients who underwent aortic arch surgery in 12 institutions in Canada were retrospectively collected. The outcomes modeled included in-hospital mortality and a modified Society of Thoracic Surgeons–defined composite for mortality or major morbidity. Multivariable logistic regression using least absolute shrinkage and selection operator selection method and mixed-effect regression model was used to select the predictors. Internal calibration of the final models is presented with an observed-versus-predicted plot. Results: There were 182 in-hospital deaths (8.0%), and the incidence of Society of Thoracic Surgeons-defined composite for mortality or major morbidity was 27.9%. Variables that increased risk of mortality are age, chronic obstructive pulmonary disease, atrial fibrillation, peripheral vascular disease, New York Heart Association class ≥III symptoms, acute aortic dissection or rupture, use of elephant trunk, concomitant surgery, and increased cardiopulmonary bypass time, with median c-statistics of 0.85 on internal validation. The c-statistics was 0.77 for the model predicting Society of Thoracic Surgeons–defined composite. Internal assessment shows good overall calibration for both models. Conclusions: We developed and internally validated a risk score for patients undergoing arch surgery requiring hypothermic circulatory arrest using a multicenter database. Once externally validated, the ARCH (Arch Reconstruction under Circulatory arrest with Hypothermia) score would allow for better patient risk-stratification and aid in the decision-making process for surgeons and patient prior to surgery.
KW - aortic arch
KW - circulatory arrest
KW - risk score
UR - http://www.scopus.com/inward/record.url?scp=85127471021&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2022.02.042
DO - 10.1016/j.jtcvs.2022.02.042
M3 - Article
AN - SCOPUS:85127471021
SN - 0022-5223
VL - 167
SP - 602-608.e2
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 2
ER -