Deep learning approach for stroke volume variation estimation: retrospective modeling and prospective deployment in real-world practice

<i>Objective</i>. We developed stroke volume variation (SVV) Net, a deep learning-based model for estimating SVV, and validated its performance and clinical applicability through both large-scale retrospective modeling and prospective real-time deployment within intraoperative settings.<i>Approach</i>. A SVVNet was trained on arterial blood pressure (ABP) waveforms from 2849 patients undergoing general anesthesia at Asan Medical Center (AMC). For retrospective validation, we utilized AMC cohorts and a publicly accessible database to assess agreement, trending ability, noise robustness (quantifies via signal quality index), and inter-individual deviation against ABP-based pulse wave analysis (ABP-PWA) and other DL models. For prospective validation, the optimized model was deployed onto a tablet and prospectively evaluated in real-time during 67 surgeries.<i>Main results</i>. In the retrospective external validation, SVVNet achieved higher agreement mean absolute error (MAE = 0.70, Pearsonρ= 0.92), compared to ABP-PWA algorithm (MAE = 1.30, Pearsonρ= 0.80) and lower inter-individual deviation. It was more robust to signal noise (MAE = 4.33 vs 30.87). In the prospective real-time deployment, our deployed model achieved an MAE of 1.33 and a Pearson correlation of 0.87 against the ground truth.<i>Significance</i>. This study emphasizes the advantages of the DL-based model compared to ABP-PWA-based algorithms and presents prospective results that support the clinical applicability of SVVNet in the operating room. Our model has the potential to replace pre-existing monitoring systems and to enhance the complex surgical environment.