Validation of the Perioperative Mortality Risk in Adults with Congenital Heart Disease (PEACH) Score in a US Cohort

The PErioperative ACHd (PEACH) score is a mortality risk assessment tool for adult congenital heart disease (ACHD) patients created to address the unique surgical risks in this population. Evaluation of the PEACH score's validity in a US cohort is needed. This paper sought to assess the PEACH score's performance in ACHD patients undergoing cardiac surgery. Secondary objectives included comparison of the PEACH score to other surgical risk assessment tools, score association with post-operative morbidities, and exploration of additional variables that may improve the score. A retrospective cohort study was conducted in ACHD patients who underwent cardiac surgery at the University of Colorado Hospitals between 2010 and 2022. Patients were identified by the institutional STS database. Components of the PEACH score and additional risk factors were evaluated by univariable analysis and subsequent logistic regression. A ROC curve compared the PEACH score to existing risk models. 516 patients were included with a median age of 30 years and 51% male. There were 9 (1.7%) deaths. Zero of 240 low-risk patients died, 6 of 229 intermediate-risk patients died (2.6%), and 3 of 41 high-risk patients died (7.3%). Model comparison revealed PEACH score AUC 0.832, ACHS score AUC 0.869, and STAT AUC 0.769. The addition of platelet level (< 150,000) improved the PEACH score (AUC 0.843, 95% CI 0.747-0.939). The PEACH score provided strong predictive ability for perioperative mortality in this ACHD cardiac surgery cohort and was associated with increased morbidity. The addition of platelet level to the score may improve its accuracy.