Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
Biostatistics Resource, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
Pediatr Cardiol. 2023 Dec;44(8):1684-1690. doi: 10.1007/s00246-023-03223-9. Epub 2023 Aug 26.
NEONATE score > 17 has been proposed as a risk factor for interstage mortality/cardiac transplant (IM/T) for patients with single ventricle physiology. Hybrid procedure is assigned 6 points, the highest possible score for that surgical variable. Most centers reserve the hybrid procedure for high-risk patients. Goal of this study was to evaluate the NEONATE score at a center that routinely performs the hybrid procedure. Retrospective chart review of patients undergoing the hybrid procedure was performed (2008-2021). Demographics and variables used for the NEONATE score were collected. Maximization of Youden's J Statistic used to determine cohort-specific optimal threshold for patients undergoing comprehensive Stage II procedure (H-CSII) versus those with IM/T (H-IM/T). Total of 120 patients met inclusion criteria (H-CSII = 105, H-IM/T = 15). Gestational age was median 39 weeks (IQR 38, 39) and birth weight was 3.18 kg (2.91, 3.57). No patient was discharged with opiates or required post-operative extracorporeal circulatory support. Optimal threshold, as selected by maximizing Youden's J Statistic, was 22. Score > 22 had a positive predictive value of 0.33 (95% CI 0.12-0.62), negative predictive values of 0.90 (95% CI 0.83-0.95), and accuracy of 0.83 (95% CI 0.75-0.90) for IM/T. At a center that routinely performs the hybrid procedure, value of > 22 had the highest accuracy. This suggests that the hybrid procedure is not necessarily intrinsically a risk-factor for IM/T, but rather patient selection for the hybrid procedure may play a larger role at centers that do not routinely perform this procedure.
新生儿评分>17 被认为是单心室生理患者的中期死亡率/心脏移植（IM/T）的风险因素。杂交手术被分配 6 分，这是该手术变量的最高分。大多数中心将杂交手术保留给高危患者。本研究的目的是评估在常规进行杂交手术的中心的新生儿评分。对接受杂交手术的患者进行回顾性图表审查（2008-2021）。收集用于新生儿评分的人口统计学和变量。最大化 Youden 的 J 统计量用于确定接受全面第二期手术（H-CSII）与接受 IM/T（H-IM/T）的患者的队列特异性最佳阈值。共 120 名患者符合纳入标准（H-CSII=105，H-IM/T=15）。胎龄中位数为 39 周（IQR 38，39），出生体重为 3.18kg（2.91，3.57）。没有患者出院时服用阿片类药物或需要术后体外循环支持。通过最大化 Youden 的 J 统计量选择的最佳阈值为 22。评分>22 的阳性预测值为 0.33（95%CI 0.12-0.62），阴性预测值为 0.90（95%CI 0.83-0.95），准确度为 0.83（95%CI 0.75-0.90）对于 IM/T。在常规进行杂交手术的中心，>22 的值具有最高的准确性。这表明杂交手术不一定是 IM/T 的固有危险因素，而是患者选择杂交手术可能在不常规进行该手术的中心发挥更大作用。
