Published online before print July 5, 2005, doi: 10.1161/CIRCULATIONAHA.104.515049
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2005;112:224-231.)
© 2005 American Heart Association, Inc.
Valvular Heart Disease |
Generic, Simple Risk Stratification Model for Heart Valve Surgery
From the Department of Statistical Science, University College (G.A., R.Z.O., P.R.); Medical Statistics Unit, R&D Directorate, University College London Hospitals NHS Trust (G.A., R.Z.O.); MRC Clinical Trials Unit (P.R.); for the Society of Cardiothoracic Surgeons of Great Britain and Ireland (R.K., B.E.K.); and Department of Cardiac Surgery, NHLI Division, Imperial College School of Medicine, Hammersmith Hospital (K.M.T.), London, UK.
Correspondence to Professor K.M. Taylor, Department of Cardiac Surgery, NHLI Division, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London W12 0NN UK. E-mail k.m.taylor{at}ic.ac.uk
Received October 19, 2004; revision received February 25, 2005; accepted March 28, 2005.
Background— Heart valve surgery has an associated in-hospital mortality rate of 4% to 8%. This study aims to develop a simple risk model to predict the risk of in-hospital mortality for patients undergoing heart valve surgery to provide information to patients and clinicians and to facilitate institutional comparisons.
Methods and Results— Data on 32 839 patients were obtained from the Society of Cardiothoracic Surgeons of Great Britain and Ireland on patients who underwent heart valve surgery between April 1995 and March 2003. Data from the first 5 years (n=16 679) were used to develop the model; its performance was evaluated on the remaining data (n=16 160). The risk model presented here is based on the combined data. The overall in-hospital mortality was 6.4%. The risk model included, in order of importance (all P<0.01), operative priority, age, renal failure, operation sequence, ejection fraction, concomitant tricuspid valve surgery, type of valve operation, concomitant CABG surgery, body mass index, preoperative arrhythmias, diabetes, gender, and hypertension. The risk model exhibited good predictive ability (Hosmer-Lemeshow test, P=0.78) and discriminated between high- and low-risk patients reasonably well (receiver-operating characteristics curve area, 0.77).
Conclusions— This is the first risk model that predicts in-hospital mortality for aortic and/or mitral heart valve patients with or without concomitant CABG. Based on a large national database of heart valve patients, this model has been evaluated successfully on patients who had valve surgery during a subsequent time period. It is simple to use, includes routinely collected variables, and provides a useful tool for patient advice and institutional comparisons.
Key Words: mortality • prognosis • risk factors • surgery • valves
This article has been cited by other articles:
 |
|
 |
|
  2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, October 7, 2008; 118(15): e523 - e661. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Vahanian, O. R. Alfieri, N. Al-Attar, M. J. Antunes, J. Bax, B. Cormier, A. Cribier, P. De Jaegere, G. Fournial, A. P. Kappetein, et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 1 - 8. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Descoutures, D. Himbert, L. Lepage, B. Iung, D. Detaint, D. Tchetche, E. Brochet, Y. Castier, J.-P. Depoix, P. Nataf, et al. Contemporary surgical or percutaneous management of severe aortic stenosis in the elderly Eur. Heart J., June 1, 2008; 29(11): 1410 - 1417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Vahanian, O. Alfieri, N. Al-Attar, M. Antunes, J. Bax, B. Cormier, A. Cribier, P. De Jaegere, G. Fournial, A. P. Kappetein, et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Eur. Heart J., June 1, 2008; 29(11): 1463 - 1470. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Iung Management of the elderly patient with aortic stenosis Heart, April 1, 2008; 94(4): 519 - 524. [Full Text] [PDF]
|
|
|
|
 |
|
 M. van Gameren, A. P. Kappetein, E. W. Steyerberg, A. C. Venema, E. A.J. Berenschot, E. L. Hannan, A. J.J.C. Bogers, and J. J.M. Takkenberg Do We Need Separate Risk Stratification Models for Hospital Mortality After Heart Valve Surgery? Ann. Thorac. Surg., March 1, 2008; 85(3): 921 - 930. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. M. Dewey, D. Brown, W. H. Ryan, M. A. Herbert, S. L. Prince, and M. J. Mack Reliability of risk algorithms in predicting early and late operative outcomes in high-risk patients undergoing aortic valve replacement J. Thorac. Cardiovasc. Surg., January 1, 2008; 135(1): 180 - 187. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Ibanez, M. Riera, J. I. Saez de Ibarra, A. Carrillo, R. Fernandez, J. Herrero, M. Fiol, and O. Bonnin Effect of preoperative mild renal dysfunction on mortality and morbidity following valve cardiac surgery Interactive CardioVascular and Thoracic Surgery, December 1, 2007; 6(6): 748 - 752. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Kalkat, M.-B. Edwards, K. M. Taylor, and R. S. Bonser Composite Aortic Valve Graft Replacement: Mortality Outcomes in a National Registry Circulation, September 11, 2007; 116(11_suppl): I-301 - I-306. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Ambler, R. Z Omar, and P. Royston A comparison of imputation techniques for handling missing predictor values in a risk model with a binary outcome Statistical Methods in Medical Research, June 1, 2007; 16(3): 277 - 298. [Abstract] [PDF]
|
|
|
|
|
|
M. Mirabel, B. Iung, G. Baron, D. Messika-Zeitoun, D. Detaint, J.-L. Vanoverschelde, E. G. Butchart, P. Ravaud, and A. Vahanian What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur. Heart J., June 1, 2007; 28(11): 1358 - 1365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kuduvalli, A. D. Grayson, J. Au, G. Grotte, B. Bridgewater, B. M. Fabri, and on behalf of the North West Quality Improvement Pr A multi-centre additive and logistic risk model for in-hospital mortality following aortic valve replacement Eur. J. Cardiothorac. Surg., April 1, 2007; 31(4): 607 - 613. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. L. Hannan, C. Wu, E. V. Bennett, R. E. Carlson, A. T. Culliford, J. P. Gold, R. S.D. Higgins, C. R. Smith, and R. H. Jones Risk Index for Predicting In-Hospital Mortality for Cardiac Valve Surgery Ann. Thorac. Surg., March 1, 2007; 83(3): 921 - 929. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B E Keogh Logistic, additive or historical: is EuroSCORE an appropriate model for comparing individual surgeons' performance? Heart, December 1, 2006; 92(12): 1715 - 1716. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Florath, A. Albert, W. Hassanein, B. Arnrich, U. Rosendahl, I. C. Ennker, and J. Ennker Current determinants of 30-day and 3-month mortality in over 2000 aortic valve replacements: impact of routine laboratory parameters Eur. J. Cardiothorac. Surg., November 1, 2006; 30(5): 716 - 721. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): 598 - 675. [Full Text] [PDF]
|
|
|
|
|
|
C. M. Otto Valvular Aortic Stenosis: Disease Severity and Timing of Intervention J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2141 - 2151. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Jones The Year in Cardiovascular Surgery J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2094 - 2107. [Full Text] [PDF]
|
|
|
|
|
|
Determinants of operative mortality in valvular heart surgery. J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 547 - 557.
|
|