Risk stratification in patients bridged to cardiac transplantation.
Patient selection is considered one of the most important factors influencing success in bridge to transplant procedures. However, to date it has been difficult to identify predictors of mortality in this population using univariate or multivariate analysis. In 1988, we developed a scoring system using 21 clinical variables that could be calculated rapidly at the bedside while evaluating potential candidates. Points were designated to these variables using a scale of 1 to 3, 1 having the least adverse effect on survival and 3 the most. Patients received a value of 0 for each variable that did not apply. This scoring system was used in a retrospective analysis for 15 bridge to transplant patients. The results showed a significant difference (p < 0.003) between the 8 survivors (mean score, 5.75 +/- 2.19) and the 7 nonsurvivors (mean score, 11.71 +/- 3.45). Since 1989, we have prospectively calculated the scores in an additional 27 patients. Based on the score, all 42 patients were divided into three groups: group I had scores of 1 to 5; group II, 6 to 10; and group III, 11 to 16. The mean score for group I (16 patients) was 3.69 +/- 1.25. All group I patients survived. Group II patients (n = 15) had a mean score of 7.87 +/- 1.36 and a survival rate of 53%. The mean score for group III (n = 11) was 13 +/- 1.73. Thirty-six percent of these patients survived. Comparison of survival and mean scores among the three groups was statistically significant (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
Swartz
M T
MT
Division of Cardiothoracic Surgery, St. Louis University Health Sciences Center, MO.
Votapka
T V
TV
McBride
L R
LR
Lohmann
D P
DP
Moroney
D A
DA
Pennington
D G
DG
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006353:Heart-Assist Devices; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri; D018579:Patient Selection; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate