TRACKing or TRUSTing transfusion prediction:Validation of Red blood cell transfusion prediction models for low transfusion rate cardiac surgery and high transfusion rate post-cardiotomy veno-arterial extracorporeal life support

Abstract bodyPreoperative identification of patients at risk of red blood cell (RBC) transfusion is necessary to prevent adverse outcomes. Several models can determine this risk. Models like TRACK, TRUST and ACTA-PORT differ in complexity and performance. Some models outperform TRACK, but their complexity limits clinical application. In 2009, the TRACK model was developed with criteria for everyday practice, simplicity and easy clinical implementation. Advances in hemodilution management in Europe has reduced transfusion rates in adult cardiac surgery, necessitating re-evaluation of the TRACK model in low transfusion rate populations.MethodsThe TRACK model was validated using 4053 adult patients who underwent cardiac surgery between 2015 and 2022. Subsequently, the database was divided at random into a derivation and validation data set. Original coefficients of the TRACK model were updated in the derivation data set and validated in a validation data set on accuracy and discriminative ability. Model calibration and discriminative ability were assessed as measures of model performance. Further, the TRACK model will be validated and updated in the same way for predicting blood transfusion in post-cardiotomy ECLS patients.ResultsAll variables but age remained significant in the external validation of the TRACK model. The odds ratio of female sex on blood transfusion increased from 1.42 to 2.42 (95% CI, 1.94 – 3.02). The original TRACK model demonstrated an area under the curve (AUC) of 0.76 (95% CI, 0.74 – 0.78) while showing poor calibration indicating overoptimistic estimation of RBC transfusion risk (p &lt; 0.05). The updated TRACK model demonstrated a slightly higher AUC of 0.78 (95% CI,0.75 – 0.81) and showed good calibration over all risk strata (p = 0.19).ConclusionsRefining the TRACK coefficients improved preoperative at-risk identification. The updated TRACK model improves predicted accuracy and may help clinicians make better discissions, especially in low-transfusion adult cardiac surgery. This study demonstrates the feasibility of RBC transfusion prediction models for adult cardiac surgery. Our ongoing study is evaluating RBC transfusion prediction models for post-cardiotomy ECLS. These results will also be presented at the conference.<br/

Effect of dissection on the mechanical properties of human ascending aorta and human ascending aorta aneurysm

The aim of the presented work is to determine (i) mechanical properties of the ascending aorta wall (DAA) and the wall of the ascending aortic aneurysm (DAAA), in which spontaneous dissection resulting from the evolving disease occurred, and (ii) the strength of the interface between the layers in the above-mentioned vessels. Methods: The mechanical tests were divided into two steps. In the first step the mechanical properties of the of DAA and DAAA walls were examined on the basis of uniaxial stretching until rapture. In the next step the mechanical parameters of the interface between layers of DAA and DAAA walls were determined by the peeling test. Results: Higher values of tensile strength (max) and Young’s modulus (E) were obtained for the DAAA group, to which the dissecting wall of the ascending aortic aneurysm was classified. For circumferential samples, the difference between the DAAA and DAA groups was 39% in the case of tensile strength and 70% in the case of the Young’s modulus. Conclusions: Summarizing, the studies performed showed that the dissection process is different in the case of the ascending aortic aneurysm wall and the ascending aorta wall. The wall of the ascending aortic aneurysm is more susceptible to dissection, as evidenced by lower values of the mechanical parameters of the interface between the intima and the media-adventitia complex. The obtained results of mechanical properties tests confirm that dissection and aneurysm should be treated as separate disease entities that may coexist with each other