Reliability of Modern Scores to Predict Long-Term Mortality After Isolated Aortic Valve Operations.
BACKGROUND
Contemporary scores for estimating perioperative death have been proposed to also predict also long-term death. The aim of the study was to evaluate the performance of the updated European System for Cardiac Operative Risk Evaluation II, The Society of Thoracic Surgeons Predicted Risk of Mortality score, and the Age, Creatinine, Left Ventricular Ejection Fraction score for predicting long-term mortality in a contemporary cohort of isolated aortic valve replacement (AVR). We also sought to develop for each score a simple algorithm based on predicted perioperative risk to predict long-term survival.


METHODS
Complete data on 1,444 patients who underwent isolated AVR in a 7-year period were retrieved from three prospective institutional databases and linked with the Italian Tax Register Information System. Data were evaluated with performance analyses and time-to-event semiparametric regression.


RESULTS
Survival was 83.0% ± 1.1% at 5 years and 67.8 ± 1.9% at 8 years. Discrimination and calibration of all three scores both worsened for prediction of death at 1 year and 5 years. Nonetheless, a significant relationship was found between long-term survival and quartiles of scores (p < 0.0001). The estimated perioperative risk by each model was used to develop an algorithm to predict long-term death. The hazard ratios for death were 1.1 (95% confidence interval, 1.07 to 1.12) for European System for Cardiac Operative Risk Evaluation II, 1.34 (95% CI, 1.28 to 1.40) for the Society of Thoracic Surgeons score, and 1.08 (95% CI, 1.06 to 1.10) for the Age, Creatinine, Left Ventricular Ejection Fraction score.


CONCLUSIONS
The predicted risk generated by European System for Cardiac Operative Risk Evaluation II, The Society of Thoracic Surgeons score, and Age, Creatinine, Left Ventricular Ejection Fraction scores cannot also be considered a direct estimate of the long-term risk for death. Nonetheless, the three scores can be used to derive an estimate of long-term risk of death in patients who undergo isolated AVR with the use of a simple algorithm.
Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy. Electronic address: fabarili@libero.it.
Fabio
F
Barili
Department of Cardiac Surgery, University of Bologna, Bologna, Italy.
Davide
D
Pacini
Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy.
Mariangela
M
D'Ovidio
Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy.
Martina
M
Ventura
Department of Cardiac Surgery, University of Milan, Milan, Italy.
Francesco
F
Alamanni
Department of Cardiac Surgery, University of Bologna, Bologna, Italy.
Roberto
R
Di Bartolomeo
Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy.
Claudio
C
Grossi
Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy.
Marina
M
Davoli
Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy.
Danilo
D
Fusco
Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy.
Carlo
C
Perucci
Unit of Cardiac Surgery and Translational Research, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Donato, University of Milan, Milan, Italy.
Alessandro
A
Parolari
D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome