A novel, comprehensive tool for predicting 30-day mortality after surgical aortic valve replacement

Fausto Biancari; Stefano Rosato; Giuliano Costa; Marco Barbanti; Paola D'Errigo; Corrado Tamburino; Francesco Cerza; Aldo Rosano; Fulvia Seccareccia; OBSERVANT Research Group

doi:10.1093/ejcts/ezaa375

A novel, comprehensive tool for predicting 30-day mortality after surgical aortic valve replacement

Eur J Cardiothorac Surg. 2021 Apr 13;59(3):586-592. doi: 10.1093/ejcts/ezaa375.

Authors

Collaborators

OBSERVANT Research Group:
Fulvia Seccareccia, Paola D'Errigo, Stefano Rosato, Alice Maraschini, Gabriella Badoni, Corrado Tamburino, Marco Barbanti, Gennaro Santoro, Marco Ranucci, Remo Daniel Covello, Rossana De Palma, Salvatore Scondotto, Sicilia Region

Affiliations

¹ Department of Surgery, University of Oulu, Oulu, Finland.
² Department of Surgery, University of Turku, Turku, Finland.
³ Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
⁴ National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy.
⁵ Division of Cardiology, Policlinico Vittorio Emanuele Hospital, University of Catania, Italy.
⁶ Italian National Agency for Regional Healthcare Services, Rome, Italy.

PMID: 33575794
DOI: 10.1093/ejcts/ezaa375

Abstract

Objectives: We sought to develop and validate a novel risk assessment tool for the prediction of 30-day mortality after surgical aortic valve replacement incorporating a patient's frailty.

Methods: Overall, 4718 patients from the multicentre study OBSERVANT was divided into derivation (n = 3539) and validation (n = 1179) cohorts. A stepwise logistic regression procedure and a criterion based on Akaike information criteria index were used to select variables associated with 30-day mortality. The performance of the regression model was compared with that of European System for Cardiac Operative Risk Evaluation (EuroSCORE) II.

Results: At 30 days, 90 (2.54%) and 35 (2.97%) patients died in the development and validation data sets, respectively. Age, chronic obstructive pulmonary disease, concomitant coronary revascularization, frailty stratified according to the Geriatric Status Scale, urgent procedure and estimated glomerular filtration rate were independent predictors of 30-day mortality. The estimated OBS AVR score showed higher discrimination (area under curve 0.76 vs 0.70, P < 0.001) and calibration (Hosmer-Lemeshow P = 0.847 vs P = 0.130) than the EuroSCORE II. The higher performances of the OBS AVR score were confirmed by the decision curve, net reclassification index (0.46, P = 0.011) and integrated discrimination improvement (0.02, P < 0.001) analyses. Five-year mortality increased significantly along increasing deciles of the OBS AVR score (P < 0.001).

Conclusions: The OBS AVR risk score showed high discrimination and calibration abilities in predicting 30-day mortality after surgical aortic valve replacement. The addition of a simplified frailty assessment into the model seems to contribute to an improved predictive ability over the EuroSCORE II. The OBS AVR risk score showed a significant association with long-term mortality.

Keywords: Aortic stenosis; Aortic valve replacement; Frailty; Performance; Score.

Publication types

Multicenter Study

MeSH terms

Aged
Aortic Valve / surgery
Aortic Valve Stenosis* / surgery
Heart Valve Prosthesis Implantation* / adverse effects
Humans
Risk Assessment
Risk Factors
Treatment Outcome