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Background: Intraoperative physiologic parameters could offer predictive utility in evaluating risk of adverse postoperative events yet are not included in current standard risk models. This study examined whether the inclusion of continuous intraoperative data improved machine learning model predictions for multiple outcomes after coronary artery bypass grafting, including 30-day mortality, renal failure, reoperation, prolonged ventilation, and combined morbidity and mortality (MM)., Methods: The Society of Thoracic Surgeons (STS) database features and risk scores were combined with retrospectively gathered continuous intraoperative data from patients. Risk models were developed for each outcome by training a logistic regression classifier on intraoperative data using 5-fold cross-validation. STS risk scores were included as offset terms in the models., Results: Compared with the STS Risk Calculator, models developed using a combination of the intraoperative features and the STS preoperative risk score had improved mean area under the receiver operating characteristic curve for prolonged ventilation (0.750 [95% CI, 0.690-0.809] vs 0.800 [95% CI, 0.750-0.851]) and MM (0.695 [95% CI, 0.644-0.746] vs 0.724 [95% CI, 0.673-0.775]). Additionally, models developed using intraoperative features had improved calibration, measured with Brier score, for prolonged ventilation (0.060 [95% CI, 0.050-0.070] vs 0.055 [95% CI, 0.045-0.065]) and MM (0.092 [95% CI, 0.081-0.103] vs 0.087 [95% CI, 0.075-0.098])., Conclusions: The inclusion of time series intraoperative data in risk models may improve early postoperative care by identifying patients who require closer monitoring postoperatively., (© 2024 The Authors.)

Objectives: The objective of this study was to evaluate contemporary clinical outcomes and identify triggers for arrhythmias or sudden death in an international cohort of Timothy Syndrome (TS) patients including those with novel TS-associated CACNA1C mutations., Background: TS is an extremely rare genetic disorder of the L-type cardiac channel Ca v 1.2 encoded by CACNA1C. The syndrome is characterized by multisystem abnormalities consisting of QT prolongation, congenital heart defects, syndactyly, facial dysmorphism, and neurological symptoms., Methods: Patients diagnosed with TS between January 1, 1994, and April 1, 2016, from 12 international tertiary care pediatric centers were included in this retrospective study. Data were gathered via survey from the patients' electrophysiologists., Results: Seventeen patients diagnosed with TS were identified. Length of follow-up was 4.9 years (range 3.0 to 19.0 years). Mean QTc was 640 ms (range 500 to 976 ms). All patients were treated with beta-blockers; 13 patients (76%) were also treated with an implantable defibrillator. Eleven patients experienced an episode of aborted cardiac arrest, 6 associated with general anesthesia and 2 with hypoglycemia. Four patients died suddenly due to ventricular fibrillation, 2 of whom had associated hypoglycemia., Conclusions: This study shows that mortality in TS patients is due to multifactorial mechanisms, which include ventricular arrhythmias, pulseless electrical activity, and hypoglycemia. A simple nomenclature for ongoing studies of TS and related syndromes is described. A worldwide prospective registry is needed for continued exploration of this syndrome., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)