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Updated: Jan 24, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
[Predictive value of 3 different risk stratification models for patients after congenital heart surgeries]
1Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
The Society of Thoracic Surgeons-European Association for cardiothoracic surgery congenital heart surgery mortality score (STAT) best predicts death after congenital heart surgery. The Aristotle basic complexity (ABC) score is superior for predicting major complications in pediatric patients.
Area of Science:
- Pediatric Cardiac Surgery
- Risk Stratification Models
- Surgical Outcomes
Background:
- Congenital heart diseases (CHDs) require complex surgical interventions in pediatric patients.
- Accurate risk stratification is crucial for predicting outcomes and guiding clinical decisions in CHD surgery.
- Existing models like RACHS-1, ABC, and STAT require evaluation for their predictive accuracy in diverse populations.
Purpose of the Study:
- To assess and compare the predictive performance of three risk stratification models: RACHS-1, ABC, and STAT.
- To evaluate their efficacy in predicting in-hospital mortality and major complications following congenital heart surgery.
- To determine the most suitable model for risk assessment in Chinese pediatric patients undergoing CHD surgery.
Main Methods:
- Retrospective analysis of 3,578 pediatric patients (<18 years) undergoing CHD surgery from January to December 2015.
- Clinical data were collected and analyzed, focusing on in-hospital mortality and major complications.
- The predictive values of RACHS-1, ABC, and STAT scores were evaluated using the area under the receiver operating characteristic (ROC) curve.
Main Results:
- Overall in-hospital mortality was 0.4% (14/3,578), and major complications occurred in 3.2% (113/3,578) of patients.
- For mortality prediction, the STAT score demonstrated the highest AUC (0.753), followed by ABC (0.722) and RACHS-1 (0.682).
- For major complications, the ABC score showed the highest AUC (0.743), followed by STAT (0.731) and RACHS-1 (0.709).
Conclusions:
- The STAT risk scoring system is superior to RACHS-1 and ABC for predicting mortality after congenital heart surgery in this cohort.
- The ABC risk scoring system demonstrates superior predictive value for major complications compared to RACHS-1 and STAT.
- These findings highlight the differential performance of risk models and suggest tailored use based on outcome prediction in Chinese pediatric CHD patients.
Abstract:
Objective: To evaluate the predictive value of 3 different risk stratification models including the risk adjustment in congenital heart surgery-1 (RACHS-1), Aristotle basic complexity (ABC), and Society of Thoracic Surgeons-European Association for cardiothoracic surgery congenital heart surgery mortality score (STAT) risk scoring system for death and major complications in patients after congenital heart surgeries. Methods: A total of 3 578 patients (age<18 years old) received surgery for congenital heart diseases from January to December 2015 in Fuwai hospital were enrolled, and the clinical data were retrospectively analyzed. The congenital heart disease patients were 1.7 (0.8, 4.5) years old, and the male accounted for 54.3% (1 943 cases).Death after surgery and major complications including use of extracorporeal membrane oxygenation, bedside thoracotomy, peritoneal dialysis for renal failure, bedside hemofiltration for renal failure, tracheotomy, reoperation for mediastinum infection, reoperation for heart in hospital were observed. The area under the receiver operating characteristic (ROC) curve was calculated to evaluate the predictive value for mortality after surgery and major complications with RACHS-1, ABC, and STAT risk scoring systems. Results: The mortality after surgery was 0.4% (14/3 578) , and the rate of major complications was 3.2% (113/3 578) . For mortality after surgery, areas under the ROC curve were 0.682 (95%CI 0.570-0.795, P=0.002), 0.722 (95%CI 0.612-0.832, P<0.001), and 0.753 (95%CI 0.659-0.847, P<0.001) with RACHS-1, ABC and STAT risk scoring systems, respectively. For major complications, areas under the ROC curve were 0.709 (95%CI 0.667-0.751, P<0.001), 0.743 (95%CI 0.702-0.784, P<0.001), and 0.731 (95%CI 0.693-0.770, P<0.001) with RACHS-1, ABC and STAT risk scoring systems, respectively. Conclusion: STAT risk scoring system is superior to RACHS-1 and ABC risk scoring systems on predicting death after surgery, and ABC risk scoring system is superior to RACHS-1 and STAT risk scoring systems on predicting major complications in Chinese patients with congenital heart disease in the single center.
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