Abstract 16262: Risk of Congenital Heart Surgery in Adults
Objective: There are currently no risk stratification models available for predicting the outcome following congenital heart surgery in adults. The Aristotle Basic Complexity (ABC), the Aristotle Comprehensive Complexity (ACC), the Risk Adjustment in Congenital Heart Surgery (RACHS-1), and the Society of Thoracic Surgeons (STS) - European Association for Cardiothoracic Surgery (EACTS) score are suitable for children. We sought to evaluate the predictive power of the ABC, ACC, RACHS-1, and STS-EACTS score for hospital mortality and complications after congenital heart surgery in adults.
Methods and results: Data of all consecutive patients aged 18 years or more, who underwent surgery for congenital heart disease between 2004 and 2014 at our institution, were collected. Complications were defined as reoperation, mechanical circulatory support, mechanical ventilatory support >24 hours, renal failure requiring dialysis, mediastinitis, persisting neurological deficit, and death during hospital admission or within 30 days. The discriminatory power of the scores was assessed using the area under the receiver operating characteristics (AuROC) curve.
846 operations were performed. Hospital mortality was 2.9%. Complications occurred in 15.6% of the patients. The prognostic significance of the ABC, ACC, RACHS-1, and STS-EACTS score for mortality was 0.67, 0.76, 0.60, and 0.74, respectively. The prognostic significance for complications was 0.65, 0.73, 0.60, and 0.70, respectively. Single ventricle physiology (p<0.001, OR=14.1) and older age (p=0.020, OR=1.04) were significant predictors for hospital mortality. Single ventricle physiology (p<0.001, OR=6.7), older age (p=0.003, OR=1.01), and male gender (p=0.022, OR=1.6) were significant predictors for complications.
Conclusions: The ACC score outperforms the ABC score since procedure dependent and independent factors are considered. The STS-EACTS score outperforms the RACHS-1 score since procedures can be categorized more precisely. The discriminative power of the ACC and the STS-EACTS score may be improved by including additional risk factors that are specifically present in the adult population.
Author Disclosures: J. Hoerer: None. M. Ono: None. J. Kasnar-Samprec: None. J. Cleuziou: None. M. Burri: None. M. Strbad: None. M. Vogt: None. R. Lange: None. C. Schreiber: None.
- © 2014 by American Heart Association, Inc.