title: Mortality Following Congenital Heart Surgery in Adults Can Be Predicted Accurately by Combining Expert-Based and Evidence-Based Pediatric Risk Scores.
abstract: Currently, there are few specific risk stratification models available to predict mortality following congenital heart surgery in adults. We sought to evaluate whether the predictive power of the common pediatric scores is applicable for adults. In addition, we evaluated a new grown-ups with congenital heart disease (GUCH) score specifically designed for adults undergoing congenital heart surgery.
  
  
  
  Data of all consecutive patients aged 18 years or more, who underwent surgery for congenital heart disease (CHD) between 2004 and 2013 at our institution, were collected. We evaluated the Aristotle Basic Complexity (ABC), the Aristotle Comprehensive Complexity (ACC), the Risk Adjustment in Congenital Heart Surgery (RACHS-1), and the Society of Thoracic Surgeons (STS)-European Association for Cardiothoracic Surgery (EACTS) scores. The proposed GUCH score consists of the STS-EACTS score, the procedure-dependent and -independent factors of the ACC score, and age. The discriminatory power of the scores was assessed using the area under the receiver-operating characteristics curve (c-index). A total of 830 operations were evaluated. Hospital mortality was 2.9%. C-indexes were 0.67, 0.80, 0.62, 0.78, and 0.84 for the ABC, ACC, RACHS-1, STS-EACTS, and GUCH mortality scores, respectively.
  
  
  
  The evidence-based EACTS-STS score outperforms the expert-based ABC score. The expert-based ACC score is superior to the evidence-based EACTS-STS score since comorbidities are considered. Our proposed GUCH score outperforms all other scores since it integrates the advantages of the evidence-based EACTS-STS score for procedures and the expert-based ACC score for comorbidities. Evidence-based scores for adults with CHD should include comorbidities and patient ages.
authors.affiliation: Department of Congenital Heart Disease, Hospital Marie Lannelongue, Université Paris-Sud, Le Plessis-Robinson, France.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hörer
authors.affiliation: Department of Cardiovascular Surgery, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany samprec@dhm.mhn.de.
authors.forename: Jelena
authors.initials: J
authors.lastname: Kasnar-Samprec
authors.affiliation: Department of Cardiovascular Surgery, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany.
authors.forename: Julie
authors.initials: J
authors.lastname: Cleuziou
authors.affiliation: Department of Cardiovascular Surgery, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Strbad
authors.affiliation: Department of Cardiovascular Surgery, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Wottke
authors.affiliation: Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Kaemmerer
authors.affiliation: Department of Cardiovascular Surgery, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schreiber
authors.affiliation: Department of Cardiovascular Surgery, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany German Center for Cardiovascular Research-Partner site Munich Heart Alliance, Munich, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D019317:Evidence-Based Medicine; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index
keywords: adult congenital heart disease; congenital heart surgery; statistics: risk analysis/modeling