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Background <p>Major adverse cardiovascular events (MACE) remain common after surgery in neonates with critical congenital heart disease (CCHD). We aimed to identify the incidence and independent risk factors for postoperative MACE and develop a predictive nomogram for individualized risk assessment.</p> Methods <p>This retrospective cohort included neonates undergoing cardiopulmonary bypass surgery for CCHD at Beijing Anzhen Hospital from January 2018 to December 2024. MACE was defined as a composite of mortality, cardiopulmonary resuscitation, unplanned reoperation, and extracorporeal membrane oxygenation (ECMO) support. Univariate and multivariable logistic regression analyses, together with least absolute shrinkage and selection operator (LASSO) regression, were used to identify independent predictors and to construct a nomogram. Model performance was evaluated by discrimination, calibration, and clinical utility.</p> Results <p>Among 302 neonates, 48 (15.89%) experienced postoperative MACE, including mortality (8.61%), cardiopulmonary resuscitation (9.60%), unplanned reoperations (8.94%), and ECMO (3.31%). Multivariable logistic regression identified low birth weight (&lt; 2.5&#xa0;kg; OR = 5.728, 95% CI 2.130–15.496), emergent surgery (OR = 3.996, 95% CI 1.458–10.878), prolonged aortic cross-clamp time (OR = 1.021, 95% CI 1.003–1.040), repeated aortic cross-clamping (OR = 5.464, 95% CI 1.002–28.377), elevated maximum vasoactive-inotropic score within 24&#xa0;h postoperatively (OR = 1.050, 95% CI 1.012–1.091), and elevated lactate at surgery completion (OR = 1.180, 95% CI 1.065–1.339) as independent risk factors for MACE, whereas prenatal diagnosis was protective (OR = 0.316, 95% CI 0.136–0.732). The nomogram demonstrated excellent performance (C-index: 0.839, AUC: 0.859) and good calibration.</p> Conclusions <p>In neonates with CCHD, independent risk factors for postoperative MACE included low birth weight, emergency surgery, prolonged or repeated ACC, elevated maximum VIS within 24&#xa0;h postoperatively, and elevated lactate at surgery completion, whereas prenatal diagnosis was protective. The nomogram accurately predicts perioperative MACE in CCHD neonates, aiding individualized risk assessment and management.</p>

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Development and validation of a nomogram for predicting major adverse cardiovascular events after neonatal surgery for critical congenital heart disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月19日

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  • Yuekun Sun,
  • Yiping Han,
  • Gang Li,
  • Yongtao Wu,
  • Jun Yan,
  • Qiang Wang

摘要

Background

Major adverse cardiovascular events (MACE) remain common after surgery in neonates with critical congenital heart disease (CCHD). We aimed to identify the incidence and independent risk factors for postoperative MACE and develop a predictive nomogram for individualized risk assessment.

Methods

This retrospective cohort included neonates undergoing cardiopulmonary bypass surgery for CCHD at Beijing Anzhen Hospital from January 2018 to December 2024. MACE was defined as a composite of mortality, cardiopulmonary resuscitation, unplanned reoperation, and extracorporeal membrane oxygenation (ECMO) support. Univariate and multivariable logistic regression analyses, together with least absolute shrinkage and selection operator (LASSO) regression, were used to identify independent predictors and to construct a nomogram. Model performance was evaluated by discrimination, calibration, and clinical utility.

Results

Among 302 neonates, 48 (15.89%) experienced postoperative MACE, including mortality (8.61%), cardiopulmonary resuscitation (9.60%), unplanned reoperations (8.94%), and ECMO (3.31%). Multivariable logistic regression identified low birth weight (< 2.5 kg; OR = 5.728, 95% CI 2.130–15.496), emergent surgery (OR = 3.996, 95% CI 1.458–10.878), prolonged aortic cross-clamp time (OR = 1.021, 95% CI 1.003–1.040), repeated aortic cross-clamping (OR = 5.464, 95% CI 1.002–28.377), elevated maximum vasoactive-inotropic score within 24 h postoperatively (OR = 1.050, 95% CI 1.012–1.091), and elevated lactate at surgery completion (OR = 1.180, 95% CI 1.065–1.339) as independent risk factors for MACE, whereas prenatal diagnosis was protective (OR = 0.316, 95% CI 0.136–0.732). The nomogram demonstrated excellent performance (C-index: 0.839, AUC: 0.859) and good calibration.

Conclusions

In neonates with CCHD, independent risk factors for postoperative MACE included low birth weight, emergency surgery, prolonged or repeated ACC, elevated maximum VIS within 24 h postoperatively, and elevated lactate at surgery completion, whereas prenatal diagnosis was protective. The nomogram accurately predicts perioperative MACE in CCHD neonates, aiding individualized risk assessment and management.