Related Experiment Video
Updated: Jun 12, 2025
Creation of Patient-Specific Silicone Cardiac Models with Applications in Pre-surgical Plans and Hands-on Training
Published on: February 10, 2022
Surgical risk scores for congenital heart surgery are useful for long-term risk prediction
Andrew Dailey-Schwartz1, Krisy Kuo2, Yanxu Yang2
1Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
Insights
Existing scoring systems accurately predict early mortality after pediatric heart surgery but show diminishing accuracy for long-term survival. New tools are needed to better predict long-term outcomes for congenital heart disease patients.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery Outcomes
- Biostatistics
Background:
- The Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STAT) and Risk Adjusted Classification for Congenital Heart Surgery (RACHS) scoring systems are established for predicting early mortality in pediatric cardiac surgery.
- However, their effectiveness in predicting long-term mortality following these procedures remains unexamined.
Purpose of the Study:
- To evaluate the ability of STAT, STAT 2020, RACHS-1, and RACHS-2 scoring systems to predict both early and long-term mortality in pediatric patients undergoing congenital heart surgery.
Main Methods:
- A retrospective cohort study utilized data from the Pediatric Cardiac Care Consortium (1982-2011).
- STAT, STAT 2020, RACHS-1, and RACHS-2 scores were applied to predict early mortality and long-term survival.
- Long-term outcomes were determined by linking patient data with the National Death Index through 2021.
Main Results:
- All scoring systems demonstrated good performance in predicting early postoperative mortality (c-statistics ranging from 0.7668 to 0.7872).
- For long-term mortality prediction, discriminative power decreased, with c-statistics ranging from 0.6741 to 0.7156.
- STAT 2020 and RACHS-2 showed the highest predictive ability for long-term mortality.
Conclusions:
- Current risk-adjusted scoring systems for congenital heart surgery maintain adequate but reduced accuracy for predicting long-term mortality.
- Further development of predictive tools is necessary to improve the assessment of long-term survival in this patient population.
Abstract:
The initial and updated Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STAT and STAT 2020) and Risk Adjusted Classification for Congenital Heart Surgery-1 and Risk Adjusted Classification for Congenital Heart Surgery-2 scoring systems are validated to predict early postoperative mortality following congenital heart surgery in children; however, their ability to predict long-term mortality has not been examined. We performed a retrospective cohort study using data from the Pediatric Cardiac Care Consortium, a US-based registry of cardiac interventions in 47 participating centres between 1982 and 2011. Patients included in this cohort analysis had select congenital heart surgery representing the spectrum of severity as determined by STAT and Risk Adjusted Classification for Congenital Heart Surgery-1 and were less than 21 years of age. We applied STAT, STAT 2020, Risk Adjusted Classification for Congenital Heart Surgery-1, and Risk Adjusted Classification for Congenital Heart Surgery-2 for prediction of early mortality and long-term postoperative survival probability by surgical risk category. Long-term outcomes were obtained by matching Pediatric Cardiac Care Consortium patients with deaths reported in the National Death Index through 2021. Of 20,753 eligible patients, 18,755 survived the postoperative period and 2,058 deaths occurred over a median follow up of 24.4 years (Interquartile Range: 21-28.4). Each scoring system performed well for predicting early postoperative mortality with the following c-statistics: STAT: 0.7872, Risk Adjusted Classification for Congenital Heart Surgery-1: 0.7872, STAT 2020: 0.7724 and Risk Adjusted Classification for Congenital Heart Surgery-2: 0.7668. The predictive ability for long-term risk of death was as follows: STAT: 0.6995, Risk Adjusted Classification for Congenital Heart Surgery-1 c = 0.6741, Risk Adjusted Classification for Congenital Heart Surgery-2: 0.7156 and STAT 2020: c = 0.7156. Risk-adjusted score systems for congenital heart surgery maintain adequate but diminishing discriminative power to predict long-term mortality. Future efforts are warranted to develop a tool with improved long-term survival prediction.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management