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Assessing surgical risk for adults with congenital heart disease: are pediatric scoring systems appropriate?
1Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
Insights
Pediatric risk scores like Aristotle and STAT can predict outcomes for adult congenital heart surgery, including mortality and major adverse events. These systems offer valuable prognostic insights for this growing patient population.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease
- Surgical Risk Stratification
Background:
- Adult congenital heart disease (ACHD) patients increasingly require surgery.
- Validated risk scoring systems for ACHD surgery are lacking.
- Predicting surgical outcomes in ACHD is challenging.
Purpose of the Study:
- To evaluate the applicability of pediatric congenital heart disease (CHD) risk scores in adults.
- To determine if existing pediatric scores can predict outcomes in adult CHD surgery.
Main Methods:
- Retrospective analysis of 458 adult CHD cardiac surgeries (2000-2010).
- Evaluation of Risk Adjustment for Congenital Heart Surgery (RACHS-1), Aristotle Basic Score, and STAT score.
- Receiver operating characteristic (ROC) curve analysis for mortality, major adverse events, and prolonged length of stay.
Main Results:
- 16% mortality, 21% major adverse events, 20% prolonged length of stay observed.
- Aristotle and STAT scores showed strong predictive ability for mortality (AUC 0.91).
- Aristotle and STAT scores also demonstrated good prediction for major adverse events and prolonged stay.
Conclusions:
- Pediatric risk scoring systems (Aristotle, STAT, RACHS-1) have prognostic value in adult CHD surgery.
- Aristotle and STAT scores are effective predictors of mortality, adverse events, and length of stay.
- The Aristotle and STAT scoring systems performed best in this adult ACHD cohort.
Background:
Patients with congenital heart disease are frequently surviving into adulthood, and many of them will require surgery. Currently, there is no validated risk scoring system for adult congenital heart surgery, and predicting outcomes in these patients is challenging. Our objective was to determine if commonly used pediatric congenital heart disease surgery risk scores are also applicable to adults.
Methods:
Four hundred fifty-eight adult (age ≥ 18 years) operations involving cardiac surgery for congenital heart disease between 2000 and 2010 at a single institution were studied retrospectively. The pediatric scores evaluated were the Risk Adjustment for Congenital Heart Surgery (RACHS-1) score, the Aristotle Basic Score, and the Society of Thoracic Surgery-European Association for Cardio-Thoracic Surgery (STAT) Congenital Heart Surgery Mortality score. Receiver operating characteristic (ROC) curves were generated to assess the ability of the scoring systems to predict mortality, major adverse events (stroke, renal failure, prolonged ventilation, prolonged coma, deep sternal infection, reoperation, and operative mortality), and prolonged length of stay (>7 days).
Results:
Of 458 operations, there were 16 (3%) deaths, 94 (21%) major adverse events, and 90 (20%) prolonged lengths of stay. Four hundred thirty (94%) of the operations were included in all 3 scoring systems and the ROC analysis. For mortality, areas under the ROC curve were 0.91, 0.91, and 0.65 for the Aristotle, STAT, and RACHS-1 scores, respectively. For major adverse event, areas under the ROC curves were 0.81, 0.76, and 0.61 for the Aristotle, STAT, and RACHS-1 scores, respectively. For prolonged length of stay, areas under the ROC curve were 0.82, 0.76, and 0.61 for the Aristotle, STAT, and RACHS-1 scores, respectively.
Conclusions:
Pediatric risk scoring systems such as Aristotle, STAT, and RACHS-1 offer prognostic value in adults undergoing congenital heart surgery. The scores are predictive of mortality, major adverse events, and prolonged lengths of stay. The STAT and Aristotle systems fared best.
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