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Published on: July 18, 2014
Evaluation of the Aristotle complexity models in adult patients with congenital heart disease
Jürgen Hörer1, Manfred Vogt, Michael Wottke
1Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University, Munich, Germany. hoerer@dhm.mhn.de
Insights
Adults with congenital heart disease (CHD) undergoing cardiac surgery have a low early mortality rate but frequent complications. The Aristotle comprehensive complexity (ACC) score shows potential for predicting hospital mortality in this growing patient population.
Area of Science:
- Cardiology
- Cardiac Surgery
- Adult Congenital Heart Disease
Background:
- The adult congenital heart disease (CHD) population now exceeds the pediatric population.
- Half of all CHD-related mortality occurs in adulthood, with some deaths during surgery.
- Identifying risk factors for adverse outcomes in adult CHD surgery is crucial.
Purpose of the Study:
- To assess risk factors for adverse outcomes in adult CHD patients undergoing cardiac operations.
- To evaluate the predictive power of Aristotle score models for hospital mortality.
- To analyze procedure-dependent and independent factors influencing surgical outcomes.
Main Methods:
- Retrospective evaluation of consecutive adult CHD patients (≥16 years) undergoing surgery (2005-2008).
- Application of Aristotle basic complexity (ABC) and comprehensive complexity (ACC) scores to each operation.
- Assessment of score discriminatory power using receiver operating characteristic (AuROC) curves.
Main Results:
- Early mortality was 2.4%, with a 53.7% early complication rate.
- Risk factors for 30-day mortality included tricuspid/mitral valve replacement and redosternotomy.
- Risk factors for complications included various valve procedures, shunt implantation, and hypothyroidism.
- ACC score demonstrated predictive power for 30-day mortality (AuROC = 0.755).
Conclusions:
- Cardiac surgery in adults with CHD can achieve low early mortality.
- Complications are common, particularly in patients needing repeat operations for atrioventricular valve issues.
- The Aristotle comprehensive complexity (ACC) score may aid in estimating early mortality risk.
Objectives:
The adult congenital heart disease (CHD) population has surpassed the paediatric CHD population. Half of all mortality caused by CHD occurs in adulthood; in some patients, it occurs during surgery. We sought to assess the potential risk factors for adverse outcome after cardiac operations in adults with CHD, and to evaluate the predictive power of the Aristotle score models for hospital mortality.
Methods:
Procedure-dependent and independent factors, as well as the outcome factors of all consecutive patients aged 16 or more who underwent surgery for CHD between 2005 and 2008 at our institution were evaluated according to the European Association for Cardio-Thoracic Surgery Congenital Database nomenclature. An Aristotle basic complexity (ABC) and an Aristotle comprehensive complexity (ACC) score were assigned to each operation. The discriminatory power of the scores was assessed using the area under the receiver operating characteristics (AuROC) curve.
Results:
During 542 operations, 773 procedures were performed. The early mortality rate was 2.4%, and the early complication rate was 53.7%. Tricuspid valve replacement (P = 0.009), mitral valve replacement (P < 0.001), elevated lung resistances (P = 0.002), hypothyroidism (P = 0.002) and redosternotomy (P = 0.003) emerged as risk factors for 30-day mortality. Tricuspid valve replacement (P < 0.001), tricuspid valvuloplasty (P = 0.006), mitral valve replacement (P = 0.003), shunt implantation (P = 0.009), surgical ablation (P = 0.024), myocardial dysfunction (P = 0.014), elevated lung resistances (P = 0.004), hypothyroidism (P = 0.002) and redosternotomy (P < 0.001) emerged as risk factors for complications. Mean ABC and ACC scores were 6.6 ± 2.3, and 9.0 ± 3.7, respectively. The AuROCs of the ABC and the ACC scores for 30-day mortality were 0.663 (P = 0.044), and 0.755 (P = 0.002), respectively. The AuROCs of the ABC and the ACC scores for complications were 0.634 (P < 0.001), and 0.670 (P < 0.001), respectively.
Conclusions:
Surgery for adults with CHD can be performed with low early mortality. However, complications are frequent, especially in patients who require repeat operations for atrioventricular valve incompetence. The ACC score may be helpful to estimate the risk of early mortality.
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