ObjectiveTo explore the anesthesia management experience in the interventional treatment of pediatric congenital heart diseases (CHD) percutaneously guided by transthoracic echocardiography (TTE) on a mobile operating platform. Methods From March to July 2023, a total of 13 patients from remote areas underwent interventional treatment for CHD on the mobile operating platform of Fuwai Yunnan Cardiovascular Hospital. Patients who received non-tracheal intubation general anesthesia were retrospectively included. ResultsEight children who had difficulty cooperating with the surgery (due to young age, emotional tension, crying) received monitored anesthesia care with local anesthesia supplemented by sedative and analgesic drugs while maintaining spontaneous breathing under the monitoring and management of an anesthesiologist (i.e., non-tracheal intubation general anesthesia). Among them, there were 5 males and 3 females, with an age of (6.95±3.29) years and a body weight of (19.50±6.04) kg. Through transthoracic echocardiography, they were diagnosed with atrial septal defect (6 patients), residual shunt after patent ductus arteriosus ligation (1 patient), and severe pulmonary valve stenosis (1 patient). The surgery proceeded smoothly, with satisfactory anesthesia and surgical effects, complete analgesia, and satisfactory postoperative recovery. There was 1 patient of body movement and 1 patient of respiratory depression during the operation, and both patients completed the surgery successfully after treatment. All children had no serious surgery- and anesthesia-related complications. The anesthesia time was 40.5 (34.5, 47.5) min, the surgery time was 39.0 (33.0, 45.5) min, and the recovery time was 43.0 (28.0, 52.5) min Conclusion Interventional surgery for CHD guided by TTE at a mobile platform is a minimally invasive approach without radiation damage. Non-tracheal intubation general anesthesia with spontaneous breathing can be safely and effectively implemented in children who cannot cooperate.
Trans-radial access (TRA) has been a common approach to percutaneous coronary intervention (PCI). Comparing with trans-femoral access (TFA), TRA is used as an alternative approach for PCI with less local complications, higher comfort level, and better outcome. In recent years, TRA has been paid more and more attention in peripheral vascular interventions. We reviewed recent developments in peripheral vascular intervention using TRA, with detail summary of the effectiveness, safety, limits, and future developments of it, aiming to improve the understanding and performance of TRA in interventionalists to benefit patients.
Objective To construct and compare logistic regression and decision tree models for predicting systemic inflammatory response syndrome (SIRS) in patients with type B aortic dissection (TBAD) after interventional surgery. Methods A retrospective analysis was conducted on clinical data of TBAD patients at Peking University Shenzhen Hospital from 2020 to 2024. The patients were divided into a SIRS group and a non SIRS group based on whether SIRS occurred within 24 hours after surgery. Multivariate logistic regression was used to analyze the influencing factors of SIRS occurrence in TBAD intervention patients, and a decision tree model was constructed using SPSS Modeler to compare the predictive performance of the two models. Results A total of 742 patients with TBAD were included, including 579 males and 163 females, aged between 27 and 97 (58.85±10.79) years. Within 24 hours after intervention, a total of 506 patients developed SIRS, with an incidence rate of 68.19%. Logistic regression analysis showed that the extensive involvement of the dissection, the surgical time≥ 2 hours, PET coated stents implanted, serum creatinine, white blood cell count, C-reactive protein, monocyte count (MONO), neutrophil count levels elevated, estimated glomerular filtration rate and decreased albumin levels were independent risk factors for SIRS (P<0.05). The decision tree model selected a total of 10 explanatory variables and 6 layers with 37 nodes, among which MONO was the most important predictor. The area under the decision tree model curve was 0.829 [95% CI (0.800, 0.856)], which was better than the logistic regression model's 0.690 [95% CI (0.655, 0.723)], and the difference was statistically significant (P<0.001). Conclusion The incidence of SIRS after TBAD intervention is high, and the decision tree model has better predictive performance than logistic regression. It can identify high-risk patients with higher accuracy and provide a practical tool for early clinical intervention.
ObjectiveTo identify the risk factors for liver failure in patients with recurrent hepatocellular carcinoma (HCC) undergoing interventional therapy after hepatectomy, and to develop a predictive nomogram. MethodsThe patients who underwent interventional therapy for recurrent HCC after hepatectomy at Haian People’s Hospital Affiliated to Nantong University from December 2018 to January 2023 were retrospectively enrolled. The patients were randomly assigned to a training set and a validation set in a 7:3 ratio. Univariate and multivariate logistic regression analyses were performed on the training set to identify the risk factors for secondary liver failure after interventional therapy for HCC. A nomogram prediction model was subsequently developed based on the identified risk factors. The discriminative ability of the predictive nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), while calibration curves and decision curve analysis (DCA) were applied to assess calibration performance and clinical utility, respectively. ResultsA total of 458 patients were included (321 patients in the training set, 137 patients in the validation set), among whom 108 (23.58%) developed liver failure. Multivariate logistic regression analysis identified the following risk factors for liver failure (all P<0.05): diabetes mellitus, liver cirrhosis, Child-Pugh grade C, intraoperative blood transfusion, prolonged hepatic inflow occlusion, remnant liver volume <40%, and elevated total bilirubin level. The nomogram constructed based on these factors achieved AUC (95%CI) of 0.887 (0.843, 0.921) in the training set and 0.820 (0.735, 0.880) in the validation set. The calibration curves approximated the ideal line, and the Hosmer-Lemeshow test indicated good agreement between predictions and observations (training set: χ2=8.849, P=0.355; validation set: χ2=8.362, P=0.399). Decision curve analysis demonstrated a high net clinical benefit within threshold probability ranges of 0.02–0.93 for the training set and 0.02–0.83 for the validation set. ConclusionsThis study suggests that for patients with high-risk factors—such as diabetes, liver cirrhosis, Child-Pugh class C, intraoperative blood transfusion, prolonged hepatic inflow occlusion, small future liver remnant volume, or elevated total bilirubin levels, who undergo interventional therapy after liver cancer resection, close attention should be paid to the risk of liver failure. The nomogram prediction model constructed based on these factors demonstrates a good performance in early risk assessment of liver failure following interventional therapy.