
==== Front
Interdiscip Cardiovasc Thorac Surg
Interdiscip Cardiovasc Thorac Surg
icvts
Interdisciplinary Cardiovascular and Thoracic Surgery
2753-670X
Oxford University Press

10.1093/icvts/ivae150
ivae150
Letter to the Editor
Eacts/118
Eacts/120
AcademicSubjects/MED00920
Reply to Condello I
https://orcid.org/0000-0002-0455-8189
Velho Tiago R Cardiothoracic Surgery Department, Hospital de Santa Maria, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal
Cardiothoracic Surgery Research Unit, Faculdade de Medicina da Universidade de Lisboa, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Lisbon, Portugal

https://orcid.org/0000-0002-9604-1223
Pereira Rafael M Cardiothoracic Surgery Research Unit, Faculdade de Medicina da Universidade de Lisboa, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Lisbon, Portugal
Escola Superior de Saúde da Cruz Vermelha Portuguesa, Lisbon, Portugal

https://orcid.org/0000-0003-0707-315X
Moita Luís F Center for Disease Mechanisms Research, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal

Corresponding author. Cardiothoracic Surgery Department, Hospital de Santa Maria, Unidade Local de Saúde de Santa Maria, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal. Tel: +351-916461073; e-mail: tiagovelho48@hotmail.com (T.R. Velho).
9 2024
29 8 2024
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06 9 2024
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
2024
https://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Cardiopulmonary bypass
Postoperative organ dysfunction
Sequential Organ Failure Assessment Score
Cardiac surgery
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pmcWe read with interest Condello’s [1] comments on our recent publication. We agree with Condello that cardiopulmonary bypass (CPB) duration alone is not the sole determinant of patient outcomes. However, the primary goal of our study was to determine the impact of CPB time on the Sequential Organ Failure Assessment (SOFA) score after cardiac surgery [2].

CPB induces a significant immunologic and inflammatory response that affects the function of virtually all tissues and organs. In our study, only 17.2% of patients showed no organ dysfunction, as assessed by the SOFA score. Beside the immediate impact of postoperative organ in the Intensive Care Unit, we have previously demonstrated that the SOFA score at the Intensive Care Unit also predicts mortality 12 and 24 months after surgery [3].

Undeniably, advances in cardiac surgery rely on innovations in CPB to achieve better outcomes and reduce associated morbidity. Therefore, research is warranted in multiple fields, including venous return techniques, optimized cannulation strategies, intraoperative management of oxygen delivery and haemoglobin, and biocompatibility, among others. CPB improvements, combined with new surgical techniques and potential pharmacological interventions, may provide better clinical benefits [4].

To develop ground-breaking interventions, we need tools to evaluate and stratify morbidity accurately. Additionally, strong evidence shows that postoperative morbidity and mortality correlate directly with CPB duration. Considering these factors, we used CPB duration as a variable to understand how it influences the overall SOFA score and for each of its systems individually.

Our article highlights the significance of the SOFA score as a valuable tool for directly assessing and classifying CPB-related postoperative organ dysfunction. Moreover, our model also has the advantage of providing the predicted probabilities for the impact of the overall SOFA score and for each of the 6 systems, according to CPB time. This enables using the SOFA score to measure organ dysfunction after CPB. New approaches and comparative studies can use the SOFA score to evaluate the impact of interventions. Our study’s major contribution is providing a quantitative tool to score organ dysfunction after CPB.

The statistical models used in our original research were specifically designed to address the primary objective of the study. Thus, the probability estimates for each SOFA category should not be generalized to other contexts. These estimates were specifically calculated to assess the increasing impact of CPB time on the dysfunction levels within each of the SOFA score systems in the analysed sample.

In conclusion, beyond measuring the impact of CPB duration on the SOFA score and its contribution to postoperative organ dysfunction, our main goal was to provide a valuable and easy tool for measuring the impact of CPB on organ dysfunction. This opens the door to using it as a quantitative outcome in future research.

FUNDING

None declared.

Conflict of interest: none declared.
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REFERENCES

1 Condello I. Optimizing cardiopulmonary bypass management beyond duration: insights from the Sequential Organ Failure Assessment Score after cardiac surgery. Interdiscip Cardiovasc Thorac Surg 2024.
2 Velho TR , PereiraRM, GuerraNC, FerreiraR, PedrosoD, Neves-CostaA et al The impact of cardiopulmonary bypass time on the Sequential Organ Failure Assessment score after cardiac surgery. Interdiscip Cardiovasc Thorac Surg 2024;38 :ivae082.
3 Velho TR , PereiraRM, PaixãoT, GuerraNC, FerreiraR, Corte-RealH et al Sequential Organ Failure Assessment score in the ICU as a predictor of long-term survival after cardiac surgery. Crit Care Explor 2022;4 :e0682.35510151
4 Banerjee D , FengJ, SellkeFW. Strategies to attenuate maladaptive inflammatory response associated with cardiopulmonary bypass. Front Surg 2024;11 :1224068.39022594
