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Performance of Four Risk Algorithms in Predicting Intermediate Survival in Patients Undergoing Aortic Valve Replacement

Tran, Henry A. MD*; Roy, Sion K. MD; Hebsur, Shrinivas MD*; Barnett, Scott D. PhD*; Schlauch, Karen A. PhD*; Hunt, Sharon L. MBA*; Holmes, Sari D. PhD* ; Ad, Niv MD*

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: November-December 2010 - Volume 5 - Issue 6 - p 407-412
doi: 10.1097/IMI.0b013e318202c349
Original Article

Objective: Several risk models exist to predict operative outcomes after cardiac surgery and are used in selecting patients for alternative procedures such as transcatheter valve implantation. We sought to evaluate the performance of the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) model in accurately identifying patients at high risk for aortic valve replacement (AVR).

Methods: Three hundred and ninety four consecutive patients who underwent isolated AVR from January 1, 2001, to July 1, 2007, at a tertiary care center were analyzed using the STS database. Patients were stratified into tertiles according to operative surgical risk calculated by the four models [STS-PROM, European system for cardiac operative risk evaluation (EuroSCORE), Ambler, and Providence]. Vital status at 1 year was determined using the National Death Index and Social Security Death Index.

Results: There were 310 low-risk patients, 56 intermediate-risk patients, and 28 high-risk patients with respect to the STS-PROM. The predicted risk of death for the low-risk, intermediate-risk, and high-risk groups were 2.4% ± 1.1%, 6.9% ± 1.4%, 15.8% ± 7.6% (P < 0.001) with respect to the STS-PROM model. Actual operative mortality for each respective group was 1.94%, 5.36%, 14.29% (P < 0.001) and 1-year mortality was 3.23%, 12.50%, 21.43% (P < 0.001), respectively.

Conclusions: High-risk patients have significantly high mortality after AVR. The STS-PROM accurately predicts operative mortality and can be used to predict 1-year survival as well. This risk model may be preferentially used instead of the EuroSCORE.

From the *Department of Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, VA USA; and †Department of Medicine, Georgetown University Hospital, Washington, DC USA.

Accepted for publication September 11, 2010.

Presented at the Annual Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, June 16–19, 2010, Berlin, Germany.

Address correspondence and reprint requests to Niv Ad, MD, Department of Cardiovascular and Thoracic Surgery, Inova Fairfax Hospital, 2921 Telestar Ct., Falls Church, VA 22042 USA. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.