Objective:

To develop a nomogram to predict the risk of prolonged mechanical ventilation (PMV) in patients undergoing acute type A aortic dissection (ATAAD) surgery.

Approach:

• Study Design: A retrospective study including 479 ATAAD patients for training and 120 for validation, following TRIPOD guidelines.
• Predictor Selection: Potential predictors were identified using LASSO regression and multivariate logistic regression.
• Nomogram Development: A nomogram was created based on retained predictors and evaluated for performance using various statistical methods.

Key Findings:

• Ten predictors were identified: age (odds ratio 1.036, 95% confidence interval 1.016–1.058, P < 0.001), preoperative serum albumin (odds ratio 0.942, 95% confidence interval 0.903–0.984, P < 0.01), fibrinogen (odds ratio 0.777, 95% confidence interval 0.643–0.938, P < 0.01), standard bicarbonate (odds ratio 0.891, 95% confidence interval 0.798–0.996, P < 0.05), red cell distribution width (odds ratio 1.325, 95% confidence interval 1.112–1.578, P < 0.01), serum creatinine (odds ratio 1.005, 95% confidence interval 1.000–1.011, P = 0.056), uric acid (odds ratio 1.002, 95% confidence interval 1.000–1.004, P < 0.05), isolated ascending aortic replacement (odds ratio 0.578, 95% confidence interval 0.348–0.960, P < 0.05), total arch replacement with frozen elephant trunk (odds ratio 1.999, 95% confidence interval 1.250–3.198, P < 0.01), and aortic cross-clamp time (odds ratio 1.010, 95% confidence interval 1.003–1.017, P < 0.01).
• The nomogram demonstrated good discriminatory ability with AUCs of 0.796 (training) and 0.765 (validation). At optimal cutoff points, the nomogram achieved a sensitivity of 78.6% and specificity of 66.7% in the training cohort.

Interpretation:

The nomogram effectively predicts the risk of PMV after ATAAD surgery, aiding in perioperative management.

Limitations:

• The study is retrospective and may be subject to selection bias.
• External validation was conducted at a single center, which may limit generalizability.

Conclusion:

The nomogram provides insights for predicting PMV in ATAAD patients.