Work

Retrospective cohort development and internal validation of a prediction model for 30-day mortality after TEVAR in type B aortic dissection

Year: 2025

Type: article

Abstract: BACKGROUND: Type B aortic dissection (BAD) carries substantial 30-day mortality despite advances in thoracic endovascular aortic repair (TEVAR), yet individualized prediction tools are lacking. METHODS: In this retrospective single-center study, 1011 consecutive patients with BAD undergoing TEVAR from January 2014 to December 2024 were randomly split 70:30 into training ( n = 708) and validation ( n = 303) cohorts. Pre- and intraoperative variables - including chronic kidney disease (CKD), admission systolic blood pressure (SBP), malperfusion syndrome, d -dimer, creatinine, maximal descending aortic diameter (Max DAD), dissection extent, and false-lumen thrombosis status - were analyzed. Variables with P < 0.05 in univariable analysis entered multivariable logistic regression to identify independent predictors. A nomogram was constructed from final coefficients, and model performance was evaluated by area under the receiver-operating characteristic curve (AUC), calibration, and decision-curve analysis (DCA). RESULTS: The overall 30-day mortality was 6.5%. Independent predictors included CKD, higher SBP, malperfusion syndrome, elevated d -dimer, higher creatinine, larger Max DAD, thoracoabdominal extent, and incomplete false-lumen thrombosis. The nomogram yielded an AUC of 0.92 (95% confidence intervals 0.88-0.96) in the training cohort and 0.91 (0.87-0.95) in the validation cohort, with good calibration and net benefit on DCA. CONCLUSIONS: This nomogram accurately predicts 30-day mortality after TEVAR in patients with BAD and may inform individualized perioperative risk stratification. External validation and prospective evaluation are warranted.

Source: International Journal of Surgery

DOI: 10.1097/js9.0000000000003593