Risk-stratification in thoracic aortic surgery: should the EuroSCORE be modified?
OBJECTIVE
Risk-stratification in cardiac surgical procedures is of major interest. Recent studies have shown, that the EuroSCORE is a very good and reliable risk-stratification score in CABG and in valve surgery. The aim of the study was to evaluate the EuroSCORE in patients undergoing surgery on the thoracic aorta.


METHODS
Three hundred and sixty-seven consecutive patients underwent surgery of the thoracic aorta and were scored, according to the additive and logistic EuroSCORE algorithm. We compared correlation of predicted and observed mortality and evaluated a modification of the EuroSCORE in order to improve the scoring system. Score validity was assessed by calculating the area under the receiver operating characteristic curve (ROC).


RESULTS
Overall hospital mortality was 10.1%. Additive EuroSCORE predicted mortality was 2.3% for 3-6% risk, 12.9% for 7-8% risk, 18.4% for 9-12% risk and 27.3% for a risk >12%. The modified score predicted mortality was 1% for 3-6% risk, 8.2% for 7-8% risk, 12.1% for 9-14% risk, 18.6% for 15-24% risk and 28.6% for a risk >24%. Area under the ROC-curve was 0.68 for the EuroScore and 0.91 in the modified score, 0.72 and 0.86 in the logistic model.


CONCLUSIONS
The modified score, taking into account aortic dissection (6 points) and preoperative malperfusion (12 points) significantly improves the predictive value of the EuroSCORE in patients undergoing thoracic aortic surgery.
Barmettler
Hanna
H
Department of Cardiovascular Surgery, University Hospital,CH-3010 Berne, Switzerland.
Immer
Franz F
FF
Berdat
Pascal A
PA
Eckstein
Friedrich S
FS
Kipfer
Beat
B
Carrel
Thierry P
TP
D000208:Acute Disease; D000368:Aged; D000465:Algorithms; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019540:Area Under Curve; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D016896:Treatment Outcome