Reply to Condello I

Cite this article as: Velho TR, Pereira RM, Moita LF. Reply to Condello I. Interdiscip CardioVasc Thorac Surg 2024; doi:10.1093/icvts/ivae150. Reply to Condello I. Tiago R. Velho a,b,� , Rafael M. Pereira b,c and Lu�ıs F. Moita d a �Corresponding author. Cardiothoracic Surgery Department, Hospital de Santa Maria, Unidade Local de Sa� ude de Santa Maria, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal. Tel: þ351-916461073; e-mail: (T.R. Velho). Received 30 July 2024; accepted 28 August 2024 Keywords: Cardiopulmonary bypass • Postoperative organ dysfunction • Sequential Organ Failure Assessment Score • Cardiac surgery We read with interest Condello’s [1] comments on our recent publication. We agree with Condello that cardiopulmonary by pass (CPB) duration alone is not the sole determinant of patient outcomes. However, the primary goal of our study was to deter mine the impact of CPB time on the Sequential Organ Failure Assessment (SOFA) score after cardiac surgery [2]. CPB induces a significant immunologic and inflammatory re sponse that affects the function of virtually all tissues and organs. In our study, only 17.2% of patients showed no organ dysfunc tion, 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 mor bidity. Therefore, research is warranted in multiple fields, includ ing venous return techniques, optimized cannulation strategies, intraoperative management of oxygen delivery and haemoglo bin, and biocompatibility, among others. CPB improvements, combined with new surgical techniques and potential pharma cological 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 cor relate 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 pro viding a quantitative tool to score organ dysfunction after CPB. The statistical models used in our original research were spe cifically 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 spe cifically 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 dys function, 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. REFERENCES [1] [2] [3] [4] Condello I. Optimizing cardiopulmonary bypass management beyond duration: insights from the Sequential Organ Failure Assessment Score after cardiac surgery. Interdiscip Cardiovasc Thorac Surg 2024. Velho TR, Pereira RM, Guerra NC, Ferreira R, Pedroso D, Neves-Costa A 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. Velho TR, Pereira RM, Paix~ao T, Guerra NC, Ferreira R, Corte-Real H 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. Banerjee D, Feng J, Sellke FW. Strategies to attenuate maladaptive in flammatory response associated with cardiopulmonary bypass. Front Surg 2024;11:1224068. © The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. 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. Cardiothoracic Surgery Department, Hospital de Santa Maria, Unidade Local de Sa� ude 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 c Escola Superior de Sa� ude da Cruz Vermelha Portuguesa, Lisbon, Portugal d Center for Disease Mechanisms Research, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal b LETTER TO THE EDITOR LETTER TO THE EDITOR Interdisciplinary CardioVascular and Thoracic Surgery 2024, 39(3), ivae150 https://doi.org/10.1093/icvts/ivae150 Advance Access publication 29 August 2024  (...truncated)