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Updated: Jan 19, 2026
An Image Guided Transapical Mitral Valve Leaflet Puncture Model of Controlled Volume Overload from Mitral Regurgitation in the Rat
Published on: May 19, 2020
The age-adjusted Charlson comorbidity index in minimally invasive mitral valve surgery
Jan-Philipp Minol1,2, Vanessa Dimitrova2, Georgi Petrov2
1Department of Vascular and Endovascular Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany.
Insights
The age-adjusted Charlson Comorbidity Index (aa-CCI) effectively predicts outcomes for minimally invasive mitral valve surgery, similar to existing scores. Patients with an aa-CCI of 8 or higher face significantly higher surgical risks.
Area of Science:
- Cardiovascular Surgery
- Medical Risk Assessment
- Health Services Research
Background:
- Mitral valve regurgitation often necessitates surgical repair.
- Minimally invasive mitral valve surgery is a common treatment approach.
- Accurate risk stratification is crucial for patient selection and management.
Purpose of the Study:
- To evaluate the predictive value of the age-adjusted Charlson Comorbidity Index (aa-CCI) in patients undergoing minimally invasive mitral valve surgery.
- To compare the predictive performance of aa-CCI against established scores like EuroSCORE II and STS score.
- To identify optimal aa-CCI cut-off values for predicting adverse events.
Main Methods:
- Analysis of 537 patients undergoing minimally invasive mitral valve surgery.
- Evaluation of 1-year mortality and other adverse events as primary endpoints.
- Comparative analysis of receiver operating characteristic curves for aa-CCI, EuroSCORE II, and STS score.
- Application of restricted cubic splines to determine aa-CCI cut-off values.
Main Results:
- The aa-CCI demonstrated predictive value comparable to EuroSCORE II and STS score.
- Patients with an aa-CCI of 8 or higher showed a significantly increased risk of mortality and adverse events.
- Optimal aa-CCI cut-off values were identified for predicting adverse outcomes.
Conclusions:
- The aa-CCI is a valuable tool for risk prediction in minimally invasive mitral valve surgery.
- It can supplement existing scores (STS, EuroSCORE II) for better risk assessment, especially in multimorbid or frail patients.
- An aa-CCI of 8 or greater indicates very high surgical risk, warranting careful consideration.
Objectives:
Mitral valve repair is the preferred method used to address mitral valve regurgitation, whereas transcatheter mitral valve repair is recommended for high-risk patients. We evaluated the risk-predictive value of the age-adjusted Charlson comorbidity index (aa-CCI) in the setting of minimally invasive mitral valve surgery.
Methods:
The perioperative course and 1-year follow-up of 537 patients who underwent isolated or combined minimally invasive mitral valve surgery were evaluated for 1-year mortality as the primary end point and other adverse events. The predictive values of the EuroSCORE II and STS score were compared to that of the aa-CCI by a comparative analysis of receiver operating characteristic curves. Restricted cubic splines were applied to find optimal aa-CCI cut-off values for the increased likelihood of experiencing the predefined adverse end points. Consequently, the perioperative course and postoperative outcome of the aa-CCI ≥8 patients and the remainder of the sample were analysed.
Results:
The predictive value of the aa-CCI does not significantly differ from those of the EuroSCORE II or STS score. Patients with an aa-CCI ≥8 were identified as a subgroup with a significant increase of mortality and other adverse events.
Conclusions:
The aa-CCI displays a suitable predictive ability for patients undergoing minimally invasive mitral valve surgery. In particular, multimorbid or frail patients may benefit from the extension of the objectively assessed parameters, in addition to the STS score or EuroSCORE II. Patients with an aa-CCI ≥8 have a very high surgical risk and should receive very careful attention.
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