Preoperative risk-of-death prediction model in heart surgery with deep hypothermic circulatory arrest in the neonate

Objective: Our goal was to generate a preoperative risk-of-death prediction model in selected neonates with congenital heart disease undergoing surger y with deep hypothermic circulatory arrest. Methods: We completed a single- center, prospective, randomized, double-blind, placebo-controlled neuroprot ection trial in selected neonates with congenital heart disease requiring o perations for which deep hypothermic circulatory arrest was used. An extens ive database was generated that included preoperative, intraoperative, and postoperative variables. Variables (delivery, maternal, and infant related) were evaluated to produce a preoperative risk-of-death prediction model by means of logistic regression. An operative risk-of-death prediction model including duration of deep hypothermic circulatory arrest was also generate d. Results: Between July 1992 and September 1997, 350 (74%) of 473 eligible infants were enrolled with 318 undergoing deep hypothermic circulatory arr est. The mortality was 52 of 318 (16.4%), unaffected by investigational dru g. The resulting preoperative risk model contained 4 variables: (1) cardiac anatomy (two-ventricle vs single ventricle surgery, with/without arch obst ruction), (2) 1-minute Apgar score (less than or equal to 5 vs >5), (3) pre sence of genetic syndrome, and (4) age at hospital admission for surgery (l ess than or equal to 5 or >5 days). Mortality for two-ventricle repair was 3.2% (4/130), Mortality for single ventricle palliation was 25.5% (48/188) and was significantly influenced by Apgar scare, genetic diagnosis, and adm ission age. The preoperative model had a prediction accuracy of 80%, The op erative risk model included duration of deep hypothermic circulatory arrest , which significantly (P = .03) increased risk of death, with a prediction accuracy of 82 %, Conclusions: In this selected population, postoperative m ortality risk is significantly affected by preoperative conditions. Identif ication of infants with varying mortality risks may affect family counselin g, therapeutic intervention, and risk stratification for future study desig ns.