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The German Aortic Valve Score II.

Wolfgang Schiller1, Linda Barnewold2, Tonia Kazmaier2

  • 1Department of Cardiac Surgery, University of Bonn, Bonn, Germany.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|September 27, 2017
PubMed
Summary

The updated German Aortic Valve Score (GAVS II) accurately predicts mortality for both surgical aortic valve replacement and transcatheter aortic valve implantation. This recalibrated score ensures reliable quality assurance in cardiac surgery.

Keywords:
Aortic valve surgeryIn-hospital mortalityRisk adjustmentRisk factorsTranscatheter aortic valve implantation

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Area of Science:

  • Cardiovascular Surgery
  • Medical Informatics
  • Health Services Research

Background:

  • The German Aortic Valve Score (GAVS) was established for national quality assurance of in-hospital mortality after isolated aortic valve replacement.
  • The increasing prevalence of transcatheter aortic valve implantation (TAVI) necessitates recalibration of existing risk scores.
  • Existing risk models may not adequately reflect outcomes in contemporary patient populations undergoing aortic valve procedures.

Purpose of the Study:

  • To recalibrate the German Aortic Valve Score (GAVS) to incorporate outcomes from both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).
  • To develop an updated risk prediction model for quality assurance in patients undergoing aortic valve interventions.
  • To ensure the GAVS remains a relevant tool for assessing in-hospital mortality in diverse patient groups.

Main Methods:

  • A total of 36,183 cases from 2011-2012 involving SAVR and TAVI (45% TAVI) were analyzed.
  • Cases were randomly allocated to a study group (18,054 patients) and a validation group.
  • A multivariable regression model with iterative backward elimination identified significant risk factors, and calibration was assessed using the Hosmer-Lemeshow test, with discrimination measured by the C-statistic.

Main Results:

  • The recalibrated model, GAVS II, identified 18 significant risk factors from an initial set of 28.
  • GAVS II demonstrated good calibration in the validation group, indicated by a non-significant Hosmer-Lemeshow test (P=0.411).
  • The model exhibited good discriminative ability, with a C-statistic of 0.741, signifying its effectiveness in predicting outcomes.

Conclusions:

  • GAVS II is a newly developed risk model validated for use in patients undergoing both surgical aortic valve replacement and transcatheter aortic valve implantation.
  • The updated score provides a reliable tool for national quality assurance and risk stratification in aortic valve interventions.
  • This recalibration ensures the GAVS remains pertinent in the evolving landscape of cardiac valve procedures.