Informed LASSO machine learning method in postoperative survival analysis of supra-cardiac total anomalous pulmonary venous connection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Xiaobing ¹ , LIU Furong ¹ , CHEN Zeyu ² , XU Guangzheng ³ , QIU Hailong ¹ , JI Erchao ¹ , LI Xiaohua ¹ , WEN Shusheng ¹ , LIU Tao ² ,  ZHUANG Jian ¹

1. Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, 510080, P. R. China;
2. Department of Biostatistics School, Public Health Brown University, Rhode Island, 02912, USA;
3. School of Social Science, Tsinghua University, Beijing, 100084, P. R. China;

Corresponding author：

ZHUANG Jian, Email: zhuangjian5413@163.com

Keywords：

Total anomalous pulmonary venous connection; risk factors; machine learning; LASSO

DOI：

10.7507/1007-4848.202103125

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To characterize surgical outcomes of supra-cardiac total anomalous pulmonary venous connection (TAPVC), investigate risk factors for postoperative death, and explore informed LASSO machine learning methods to solve "small sample size problem" in research of rare congenital heart diseases.Methods A retrospective analysis of 241 patients with supra-cardiac TAPVC who underwent surgical repair in Guangdong Provincial People's Hospital from 2009 to 2019 was conducted, including 179 males and 62 females with a median surgical age of 71 (33, 232) d.Detailed clinical data of the postoperative death-related factors were extracted. Univariable Cox proportional hazard models were used to initially screen potential risk factors for postoperative death. Factors with P≤0.05 were retained. To solve the limitation of small sample size and the "P>n" problem, we proposed a novel LASSO method for conducting multivariable Cox regression analysis that was capable of bringing in findings of related studies to improve analysis power and to reduce false-negative findings.Results Univariable Cox analyses showed several potential clinical risk factors, among which highly significant factors (P<0.001) included: surgical weight≤2.5 kg (HR=16.00), main pulmonary artery diameter (HR=0.78), prolonged cardiopulmonary bypass time (HR=1.21), aortic block time (HR=1.28), and postoperative ventilator-assisted time (HR=1.13/d). LASSO multivariable analysis revealed that independent risk factors for postoperative death included cardiopulmonary bypass time (aHR=1.308/30 min), age (aHR=0.898), postoperative ventilator-assisted time (aHR=1.023/d), weight≤2.5 kg (aHR=2.545), right vertical venous return (aHR=1.977), preoperative pulmonary venous obstruction (aHR=1.633) and emergency surgery (aHR=1.383).Conclusion Our proposed informed LASSO method can use previous studies' results to improve the power of analysis and effectively solve the "P>n" and small sample size limitation. Cardiopulmonary bypass time, surgical age, postoperative ventilator-assisted time, weight, right vertical venous return, preoperative pulmonary venous obstruction, and emergency surgery are risk factors for postoperative death of supra-cardiac TAPVC.

Citation： LIU Xiaobing, LIU Furong, CHEN Zeyu, XU Guangzheng, QIU Hailong, JI Erchao, LI Xiaohua, WEN Shusheng, LIU Tao, ZHUANG Jian. Informed LASSO machine learning method in postoperative survival analysis of supra-cardiac total anomalous pulmonary venous connection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(7): 848-853. doi: 10.7507/1007-4848.202103125 Copy

1.	Herlong JR, Jaggers JJ, Ungerleider RM. Congenital heart surgery nomenclature and database project: Pulmonary venous anomalies. Ann Thorac Surg, 2000, 69(4 Suppl): S56-S69.
2.	Shi G, Zhu Z, Chen J, et al. Total anomalous pulmonary venous connection: The current management strategies in a pediatric cohort of 768 patients. Circulation, 2017, 135(1): 48-58.
3.	Kim J. Big data, health informatics, and the future of cardiovascular medicine. J Am Coll Cardiol, 2017, 69(7): 899-902.
4.	Mayer-Schönberger V. Big data for cardiology: Novel discovery? Eur Heart J, 2016, 37(12): 996-1001.
5.	Tibshirani R. Regression shrinkage and selection via the Lasso. J R Statist Soc B, 1996, 58(1): 267-288.
6.	M-Therneau T, M-Grambsch P. Modeling Survival Data: Extending the Cox Model. New York: Springer, 2000. 39-77.
7.	Liufu R, Shi G, Zhu F, et al. Superior approach for supracardiac total anomalous pulmonary venous connection. Ann Thorac Surg, 2018, 105(5): 1429-1435.
8.	Ding YQ, Chen JM, Cen JZ, et al. Extended anastomosis with suture-less technique for primary repair of supra-cardiac TAPVC. South China J Cardio, 2010, 11(4): 222-227.
9.	李晓华, 庄建, 陈寄梅, 等. 新生儿完全性肺静脉异位引流的矫治及预后相关危险因素分析. 中国胸心血管外科临床杂志, 2015, 22(12): 1138-1142.
10.	Zhang C, Ou Y, Zhuang J, et al. Comparison of sutureless and conventional techniques to repair total anomalous pulmonary venous connection. Semin Thorac Cardiovasc Surg, 2016, 28(2): 473-484.
11.	李晓华, 陈寄梅, 庄建, 等. Sutureless 技术在新生儿完全性肺静脉异位引流中的应用. 中国胸心血管外科临床杂志, 2017, 24(9): 661-666.
12.	Johnson BA, Lin DY, Zeng D. Penalized estimating functions and variable selection in semiparametric regression models. J Am Stat Assoc, 2008, 103(482): 672-680.
13.	Yong MS, Yaftian N, Griffiths S, et al. Long-term outcomes of total anomalous pulmonary venous drainage repair in neonates and infants. Ann Thorac Surg, 2018, 105(4): 1232-1238.
14.	White BR, Ho DY, Faerber JA, et al. Repair of total anomalous pulmonary venous connection: Risk factors for postoperative obstruction. Ann Thorac Surg, 2019, 108(1): 122-129.
15.	Karamlou T, Gurofsky R, Al Sukhni E, et al. Factors associated with mortality and reoperation in 377 children with total anomalous pulmonary venous connection. Circulation, 2007, 115(12): 1591-1598.
16.	Yun TJ, Coles JG, Konstantinov IE, et al. Conventional and sutureless techniques for management of the pulmonary veins: Evolution of indications from postrepair pulmonary vein stenosis to primary pulmonary vein anomalies. J Thorac Cardiovasc Surg, 2005, 129(1): 167-174.
17.	Hörer J, Neuray C, Vogt M, et al. What to expect after repair of total anomalous pulmonary venous connection: Data from 193 patients and 2902 patient years. Eur J Cardiothorac Surg, 2013, 44(5): 800-807.
18.	Seale AN, Uemura H, Webber SA, et al. Total anomalous pulmonary venous connection: Morphology and outcome from an international population-based study. Circulation, 2010, 122(25): 2718-2726.
19.	Brown VE, De Lange M, Dyar DA, et al. Echocardiographic spectrum of supracardiac total anomalous pulmonary venous connection. J Am Soc Echocardiogr, 1998, 11(3): 289-293.
20.	Muntean I, Mărginean C, Stanca R, et al. Prenatal diagnoses of an uncommon isolated obstructed supracardiac total anomalous pulmonary venous connection: Case report and review of the literature (CARE compliant). Medicine (Baltimore), 2017, 96(5): e6061.
21.	Sakamoto T, Nagashima M, Umezu K, et al. Long-term outcomes of total correction for isolated total anomalous pulmonary venous connection: Lessons from 50-years' experience. Interact Cardiovasc Thorac Surg, 2018, 27(1): 20-26.

1. Herlong JR, Jaggers JJ, Ungerleider RM. Congenital heart surgery nomenclature and database project: Pulmonary venous anomalies. Ann Thorac Surg, 2000, 69(4 Suppl): S56-S69.
2. Shi G, Zhu Z, Chen J, et al. Total anomalous pulmonary venous connection: The current management strategies in a pediatric cohort of 768 patients. Circulation, 2017, 135(1): 48-58.
3. Kim J. Big data, health informatics, and the future of cardiovascular medicine. J Am Coll Cardiol, 2017, 69(7): 899-902.
4. Mayer-Schönberger V. Big data for cardiology: Novel discovery? Eur Heart J, 2016, 37(12): 996-1001.
5. Tibshirani R. Regression shrinkage and selection via the Lasso. J R Statist Soc B, 1996, 58(1): 267-288.
6. M-Therneau T, M-Grambsch P. Modeling Survival Data: Extending the Cox Model. New York: Springer, 2000. 39-77.
7. Liufu R, Shi G, Zhu F, et al. Superior approach for supracardiac total anomalous pulmonary venous connection. Ann Thorac Surg, 2018, 105(5): 1429-1435.
8. Ding YQ, Chen JM, Cen JZ, et al. Extended anastomosis with suture-less technique for primary repair of supra-cardiac TAPVC. South China J Cardio, 2010, 11(4): 222-227.
9. 李晓华, 庄建, 陈寄梅, 等. 新生儿完全性肺静脉异位引流的矫治及预后相关危险因素分析. 中国胸心血管外科临床杂志, 2015, 22(12): 1138-1142.
10. Zhang C, Ou Y, Zhuang J, et al. Comparison of sutureless and conventional techniques to repair total anomalous pulmonary venous connection. Semin Thorac Cardiovasc Surg, 2016, 28(2): 473-484.
11. 李晓华, 陈寄梅, 庄建, 等. Sutureless 技术在新生儿完全性肺静脉异位引流中的应用. 中国胸心血管外科临床杂志, 2017, 24(9): 661-666.
12. Johnson BA, Lin DY, Zeng D. Penalized estimating functions and variable selection in semiparametric regression models. J Am Stat Assoc, 2008, 103(482): 672-680.
13. Yong MS, Yaftian N, Griffiths S, et al. Long-term outcomes of total anomalous pulmonary venous drainage repair in neonates and infants. Ann Thorac Surg, 2018, 105(4): 1232-1238.
14. White BR, Ho DY, Faerber JA, et al. Repair of total anomalous pulmonary venous connection: Risk factors for postoperative obstruction. Ann Thorac Surg, 2019, 108(1): 122-129.
15. Karamlou T, Gurofsky R, Al Sukhni E, et al. Factors associated with mortality and reoperation in 377 children with total anomalous pulmonary venous connection. Circulation, 2007, 115(12): 1591-1598.
16. Yun TJ, Coles JG, Konstantinov IE, et al. Conventional and sutureless techniques for management of the pulmonary veins: Evolution of indications from postrepair pulmonary vein stenosis to primary pulmonary vein anomalies. J Thorac Cardiovasc Surg, 2005, 129(1): 167-174.
17. Hörer J, Neuray C, Vogt M, et al. What to expect after repair of total anomalous pulmonary venous connection: Data from 193 patients and 2902 patient years. Eur J Cardiothorac Surg, 2013, 44(5): 800-807.
18. Seale AN, Uemura H, Webber SA, et al. Total anomalous pulmonary venous connection: Morphology and outcome from an international population-based study. Circulation, 2010, 122(25): 2718-2726.
19. Brown VE, De Lange M, Dyar DA, et al. Echocardiographic spectrum of supracardiac total anomalous pulmonary venous connection. J Am Soc Echocardiogr, 1998, 11(3): 289-293.
20. Muntean I, Mărginean C, Stanca R, et al. Prenatal diagnoses of an uncommon isolated obstructed supracardiac total anomalous pulmonary venous connection: Case report and review of the literature (CARE compliant). Medicine (Baltimore), 2017, 96(5): e6061.
21. Sakamoto T, Nagashima M, Umezu K, et al. Long-term outcomes of total correction for isolated total anomalous pulmonary venous connection: Lessons from 50-years' experience. Interact Cardiovasc Thorac Surg, 2018, 27(1): 20-26.

Previous Article
“Multiple to one” anastomosis during liver transplantation in recipients with complex portal vein thrombosis
Next Article
Progress and prospects of The Human Cell Atlas

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Informed LASSO machine learning method in postoperative survival analysis of supra-cardiac total anomalous pulmonary venous connection

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content