Pediatric Cardiac Surgery

Jacobs, Marshall L.

doi:10.1161/circulationaha.114.014318

Cited by 9 publications

(4 citation statements)

References 17 publications

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“…Die Mehrzahl dieser Herzfehler geht mit einer signifikanten Morbidität und Mortalität einher. Jedoch hat der medizinische Fortschritt seit der ersten erfolgreichen chirurgischen Unterbindung eines offenen Ductus Botalli 1938 in Boston durch Robert Gross (in Cyclopropananästhesie) bewirkt, dass seit Mitte der 1980er Jahre nahezu alle Herzfehler therapierbar geworden sind [4,5]. Durch kontinuierliche Weiterentwicklungen der kardiologischen Diagnostik, des anästhesiologischen Managements, der chirurgischen Techniken und der Intensivmedizin ist selbst bei komplexen Herzfehlern, wie z.…”

Section: Patienten Mit Angeborenen Herzfehlernunclassified

„Überlebende“

Müller

2015

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Section: Patienten Mit Angeborenen Herzfehlernunclassified

„Überlebende“

Müller

2015

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“…An increasing number of pediatric patients worldwide undergo cardiac surgery each year for various reasons, including congenital heart disease and acquired cardiac conditions [ 1 ]. Cardiac surgery–associated acute kidney injury (CSA-AKI), characterized by an abrupt decrease in renal function, is a major complication following pediatric cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Machine Learning–Based Prediction of Acute Kidney Injury Following Pediatric Cardiac Surgery: Model Development and Validation Study

Luo¹,

Kang²,

Duan³

et al. 2023

J Med Internet Res

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Background Cardiac surgery–associated acute kidney injury (CSA-AKI) is a major complication following pediatric cardiac surgery, which is associated with increased morbidity and mortality. The early prediction of CSA-AKI before and immediately after surgery could significantly improve the implementation of preventive and therapeutic strategies during the perioperative periods. However, there is limited clinical information on how to identify pediatric patients at high risk of CSA-AKI. Objective The study aims to develop and validate machine learning models to predict the development of CSA-AKI in the pediatric population. Methods This retrospective cohort study enrolled patients aged 1 month to 18 years who underwent cardiac surgery with cardiopulmonary bypass at 3 medical centers of Central South University in China. CSA-AKI was defined according to the 2012 Kidney Disease: Improving Global Outcomes criteria. Feature selection was applied separately to 2 data sets: the preoperative data set and the combined preoperative and intraoperative data set. Multiple machine learning algorithms were tested, including K-nearest neighbor, naive Bayes, support vector machines, random forest, extreme gradient boosting (XGBoost), and neural networks. The best performing model was identified in cross-validation by using the area under the receiver operating characteristic curve (AUROC). Model interpretations were generated using the Shapley additive explanations (SHAP) method. Results A total of 3278 patients from one of the centers were used for model derivation, while 585 patients from another 2 centers served as the external validation cohort. CSA-AKI occurred in 564 (17.2%) patients in the derivation cohort and 51 (8.7%) patients in the external validation cohort. Among the considered machine learning models, the XGBoost models achieved the best predictive performance in cross-validation. The AUROC of the XGBoost model using only the preoperative variables was 0.890 (95% CI 0.876-0.906) in the derivation cohort and 0.857 (95% CI 0.800-0.903) in the external validation cohort. When the intraoperative variables were included, the AUROC increased to 0.912 (95% CI 0.899-0.924) and 0.889 (95% CI 0.844-0.920) in the 2 cohorts, respectively. The SHAP method revealed that baseline serum creatinine level, perfusion time, body length, operation time, and intraoperative blood loss were the top 5 predictors of CSA-AKI. Conclusions The interpretable XGBoost models provide practical tools for the early prediction of CSA-AKI, which are valuable for risk stratification and perioperative management of pediatric patients undergoing cardiac surgery.

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“…Many children with CHD will undergo one or several high‐risk invasive procedures, such as cardiac surgery and/or interventional cardiac catheterization . Such events represent major disruptions within the family circle and parental psychological trauma may occur soon after prenatal or postnatal diagnosis .…”

Section: Introductionmentioning

confidence: 99%

Parental anxiety before invasive cardiac procedure in children with congenital heart disease: Contributing factors and consequences

Werner

Louali

Fouilloux

et al. 2019

Congenital Heart Disease

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Objective Medical information provided to parents of a child with a congenital heart disease can induce major stress. Visual analog scales have been validated to assess anxiety in the adult population. The aim of this study was to analyze parental anxiety using a visual analog scale and to explore the influencing factors. Design This prospective cross‐sectional study. Setting Tertiary care regional referral center for congenital heart disease of Marseille—La Timone university hospital. Patients Parents of children with a congenital heart disease, as defined by the ACC‐CHD classification, referred for cardiac surgery or interventional cardiac catheterization, were offered to participate. Intervention and outcome measure The parental level of anxiety was assessed using a visual analog scale (0‐10) before intervention and after complete information given by the cardiologist, the surgeon or the anesthetists. Results Seventy‐three children [7 days‐13 years], represented by 49 fathers and 71 mothers, were included in the study. A total of 42 children required cardiac surgery and 31 children underwent interventional cardiac catheterization. The mean score of maternal anxiety was significantly higher than the paternal anxiety (8.2 vs 6.3, P < .01). A high level of maternal anxiety (visual analog scale > 8) was associated with paternal anxiety (P = .02), the child's comorbidity (P = .03), the distance between home and referral center (P = .04), and the level of risk adjustment for congenital heart surgery (P = .01). In multivariate analysis, maternal anxiety was associated with paternal anxiety (OR = 4.9; 95% confidence interval [1.1‐19.2]), and the level of risk adjustment for congenital heart surgery (OR = 11.4; 95% confidence interval [1.2‐116.2]). No significant association was found between parental anxiety and prenatal diagnosis. Conclusion This study highlighted several factors associated with the parental anxiety. Identifying the parents at risk of high stress can be useful to set up psychological support during hospitalization.

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Pediatric Cardiac Surgery

Cited by 9 publications

References 17 publications

„Überlebende“

„Überlebende“

Machine Learning–Based Prediction of Acute Kidney Injury Following Pediatric Cardiac Surgery: Model Development and Validation Study

Parental anxiety before invasive cardiac procedure in children with congenital heart disease: Contributing factors and consequences

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