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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
External Validation of 3 Risk Scores in Adults with Congenital Heart Disease
Bunty K Ramchandani1, Luz Polo2, Raúl Sánchez2
1Section of Cardiac Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain. bunty.r@gmail.com.
Insights
The Risk Adjustment for Congenital Heart Surgery (RACHS-1) score is the most accurate for predicting surgical mortality in adults with congenital heart disease (CHD). This study found RACHS-1 to be well-calibrated, unlike the Euroscore I system.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease
- Surgical Risk Assessment
Background:
- Adult congenital heart disease (CHD) patient numbers are rising due to improved pediatric survival rates.
- A significant portion of adults with CHD require surgical intervention during their lifetime.
- Current risk scores inadequately predict mortality for these complex surgical procedures.
Purpose of the Study:
- To evaluate the accuracy of existing risk scores for predicting mortality in adult CHD surgical patients.
- To compare the performance of RACHS-1, Aristotle, and Euroscore I in this specific patient population.
Main Methods:
- Analysis of 608 surgical procedures performed on adults with CHD between May 1991 and June 2017.
- Evaluation of three risk scores: RACHS-1, Aristotle, and Euroscore I.
- Statistical analysis using the area under the receiver operating characteristic curve (c-index) for discrimination and Hosmer-Lemeshow (H-L) statistic for calibration.
Main Results:
- No significant difference in discrimination (c-index) was found among the three risk scores.
- RACHS-1 and Aristotle scores demonstrated good calibration without evidence of lack of fit.
- Euroscore I showed significant calibration issues (H-L p<0.001), indicating poor predictive accuracy.
Conclusions:
- The RACHS-1 scoring system appears to be the most reliable for assessing surgical mortality risk in adults with CHD.
- RACHS-1 offers better calibration compared to Euroscore I for this patient group.
Background And Objectives:
Adults with congenital heart disease (CHD) are an increasing group of patients thanks to the survival of over 85% of children with CHD. 20% of these patients shall warrant a surgical procedure during their life span. However, currently there is no one risk score that assess correctly the mortality of these procedures. Thus, we analyse the risk scores used at our institution.
Methods:
From May 1991 till June 2017, 608 procedures in adults with CHD were performed. The 3 risk scores (risk adjustment for congenital heart surgery [RACHS-1], Aristotle, and Euroscore I) of each procedure were analysed. We used area under the receiver operating characteristic curve (c-index) to measure model discrimination, and Hosmer-Lemeshow (H-L) statistic along with calibration plots to measure calibration.
Results:
There was no statistical difference between the area under the curve for the 3 scores (χ²=0.58 with 2 df, p=0.750). There was no evidence of lack of fit for RACHS-1 (H-L, χ²=2.61; p=0.271) and Aristotle score (H-L, χ²=5.69; p=0.459). However, there was evidence in lack of calibration in the Euroscore I scoring system (H-L, χ²=33.69; p<0.001). The calibration slope for RACHS-1 was 0.912, for Aristotle (stratified in risk groups) was -0.14 and for Euroscore 1 (stratified in risk groups) was 0.46.
Conclusions:
RACHS-1 seems to be best risk scoring system for calculating mortality applied to surgery in adults with CHD.
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