Predictive Value of EuroSCORE II in Patients Undergoing Left Ventricular Assist Device Therapy.
Background Left ventricular assist devices (LVADs) are nowadays a widespread option for the effective treatment of heart failure. We hypothesized that the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) might be a superior tool in clinical decision making compared with other established score systems. Methods In this retrospective, single-center analysis, between 2008 and 2014, 40 consecutive patients were followed for up to 36 months after LVAD (Thoratec HeartMate II) implantation. Postoperative survival was correlated to the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) levels, Destination Therapy Risk Score (DTRS), HeartMate II Risk Score (HMRS), and EuroSCORE II. Results Overall, a positive outcome (survival, transplantation, or weaning) was reached in 87.5% (30 days), 70% (1 year), and 60% (2 and 3 years) of cases. Patients were categorized as high, medium, and low risk by use of the different scores. Within the created subgroups, the following 1-year positive outcomes were achieved-INTERMACS: high risk 58% versus low risk 68%; EuroSCORE II: high risk 17% versus low risk 89%; DTRS: high risk 44% versus low risk 75%; and HMRS: high risk 60% versus low risk 100%. After 1 year, the EuroSCORE II classification's area under the receiver operating characteristic curve (AUC) was superior (AUC = 0.78) and Fisher exact test revealed a significant predictive value for this classification (p = 0.0037) but not for INTERMACS levels, DTRS, or HMRS classifications. Conclusion These results support the assumption that EuroSCORE II risk classification may be useful to predict survival in LVAD patients. In our observation, it proved to be superior to INTERMACS, DTRS, and HMRS after 1 year.
Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
Ares K
AK
Menon
Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
Mare
M
Mechelinck
Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
Jan
J
Unterkofler
Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
Andreas
A
Goetzenich
Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
Rüdiger
R
Autschbach
Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
Lachmandath
L
Tewarie
Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
Ajay
A
Moza
D000328:Adult; D000368:Aged; D019540:Area Under Curve; D003661:Decision Support Techniques; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D012372:ROC Curve; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left