Nuclear Cell-Free DNA Predicts Adverse Events After Pediatric Cardiothoracic Surgery. Ann Thorac Surg 2023 Aug;116(2):349-356
Date
11/05/2022Pubmed ID
36332680DOI
10.1016/j.athoracsur.2022.10.027Scopus ID
2-s2.0-85150823960 (requires institutional sign-in at Scopus site) 1 CitationAbstract
BACKGROUND: Preoperative risk stratification in cardiac surgery includes patient and procedure factors that are used in clinical decision-making. Despite these tools, unidentified factors contribute to variation in outcomes. Identification of latent physiologic risk factors may strengthen predictive models. Nuclear cell-free DNA (ncfDNA) increases with tissue injury and drops to baseline levels rapidly. The goal of this investigation is to measure and to observe ncfDNA kinetics in children undergoing heart operations with cardiopulmonary bypass (CPB), linking biomarkers, organ dysfunction, and outcomes.
METHODS: This is a prospective observational study of 116 children <18 years and >3 kg undergoing operations with CPB. Plasma ncfDNA samples were collected and processed in a stepwise manner at predefined perioperative time points. The primary outcome measure was occurrence of postoperative cardiac arrest or extracorporeal membrane oxygenation.
RESULTS: Data were available in 116 patients (median age, 0.9 years [range, 0-17.4 years]; median weight, 7.8 kg [range, 3.2-98 kg]). The primary outcome was met in 6 of 116 (5.2%). Risk of primary outcome was 2% with ncfDNA <20 ng/mL and 33% with ncfDNA >20 ng/mL (odds ratio, 25; CI, 3.96-158; P = .001). Elevated ncfDNA was associated with fewer hospital-free days (P < .01).
CONCLUSIONS: This study analyzes ncfDNA kinetics in children undergoing operations with CPB for congenital heart disease. Elevated preoperative ncfDNA is strongly associated with postoperative arrest and extracorporeal membrane oxygenation. Further studies are needed to validate this technology as a tool to predict morbidity in children after cardiac surgical procedures.
Author List
Tanem JM, Scott JP, Hoffman GM, Niebler RA, Tomita-Mitchell A, Stamm KD, Liang HL, North PE, Bertrandt RA, Woods RK, Hraska V, Mitchell MEAuthors
Rebecca Ann Bertrandt MD Associate Professor in the Pediatrics department at Medical College of WisconsinGeorge M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Viktor Hraska MD Professor in the Surgery department at Medical College of Wisconsin
Michael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Robert Niebler MD Professor in the Pediatrics department at Medical College of Wisconsin
Paula E. North MD, PhD Professor in the Pathology department at Medical College of Wisconsin
John P. Scott MD Professor in the Anesthesiology department at Medical College of Wisconsin
Justinn M. Tanem MD Assistant Professor in the Anesthesiology department at Medical College of Wisconsin
Ronald K. Woods MD Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Cardiac Surgical ProceduresCardiopulmonary Bypass
Child
Heart Defects, Congenital
Humans
Infant
Prospective Studies
Risk Factors
