Validation of European System for Cardiac Operative Risk Evaluation Ⅱ in Predicting the Mortality and Prolonged Intensive Care Unit Stay after Sun's Procedure for Stanford type A Aortic Dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GEYi-peng , CHENLei , LICheng-nan , XIAYu , GUOShi-chao , LIUWei , ZHUJun-ming , LIUYong-min ,  SUNLi-zhong

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China;

Corresponding author：

SUNLi-zhong, Email: lizhongsun@outlook.com

Keywords：

EuroSCORE Ⅱ; Mortality; Aortic dissection; Intensive care unit

DOI：

10.7507/1007-4848.20150006

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the validity of European System for Cardiac Operative Risk Evaluation (EuroSCORE) Ⅱ for predicting in-hospital mortality and prolonged ICU stay after Sun's procedure (total aortic arch replacement with stented elephant trunk implantation) for Stanford type A aortic dissection (STAAD). Methods Clinical data of 384 STAAD patients undergoing Sun's procedure in Beijing Anzhen Hospital between February 2009 and February 2012 were retrospectively analyzed, including 228 (59.38%) patients with acute STAAD. Accoding to EuroSCORE Ⅱ to predict postoperative mortality, all the patients were divided into a low-risk group, a medium-risk group, a high-risk group and an extremely-high-risk group. There were 296 patients including 52 females in the low-risk group with their age of 45.39±10.75 years, 70 patients including 19 females in the medium-risk group with their age of 47.67±11.26 years, 13 patients including 5 females in the high-risk group with their age of 53.08±4.94 years, and 5 patients including 1 female patient in the extremely-high-risk group with their age of 41.60±11.08 years. All the patients received Sun's procedure under deep hypothermic circulatory arrest and antegrade selective cerebral perfusion. EuroSCORE Ⅱ was used to predict postoperative mortality and prolonged ICU stay. Results In-hospital mortality was 8.07% (31/384). Mean length of ICU stay was 3.06 days. Length of ICU stay of 42 patients was longer than 7 days. For low-risk group, the predicted mortality was lower than the actual mortality. For medium-risk, high-risk and extremely-high-risk groups, the predicted mortality was higher than the actual mortality. EuroSCORE Ⅱ showed unsatisfactory discriminatory ability to predict postoperative mortality and prolonged ICU stay. The area under ROC curve were 0.49 and 0.52 respectively. The calibration was also poor for predicting postoperative mortality and prolonged ICU stay (P<0.001). Conclusions EuroSCORE Ⅱ is not satisfactory for predicting mortality and prolonged ICU stay after Sun's procedure for the treatment of STAAD. A new risk evaluating system specific for STAAD is needed.

Citation： GEYi-peng, CHENLei, LICheng-nan, XIAYu, GUOShi-chao, LIUWei, ZHUJun-ming, LIUYong-min, SUNLi-zhong. Validation of European System for Cardiac Operative Risk Evaluation Ⅱ in Predicting the Mortality and Prolonged Intensive Care Unit Stay after Sun's Procedure for Stanford type A Aortic Dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(1): 23-26. doi: 10.7507/1007-4848.20150006 Copy

1.	Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation:a new "standard" therapy for type a dissection involving repair of the aortic arch? Circulation, 2011, 123(9):971-978.
2.	Nissinen J, Biancari F, Wistbacka JO, et al. Is it possible to improve the accuracy of EuroSCORE? Eur J Cardiothorac Surg, 2009, 36(5):799-804.
3.	Akar AR, Kurtcephe M, Sener E, et al. Validation of the EuroSCORE risk models in Turkish adult cardiac surgical population. Eur J Cardiothorac Surg, 2011, 40(3):730-735.
4.	Yap CH, Reid C, Yii M, et al. Validation of the EuroSCORE model in Australia. Eur J Cardiothorac Surg, 2006, 29(4):441-446.
5.	Basraon J, Chandrashekhar YS, John R, et al. Comparison of risk scores to estimate perioperative mortality in aortic valve replacement surgery. Ann Thorac Surg, 2011, 92(2):535-540.
6.	葛翼鹏, 许建屏, 孙立忠. 欧洲心脏手术风险评估系统预测中国人心瓣膜手术后并发症的发生及预后. 中国胸心血管外科临床杂志, 2010, 17(5):357-359.
7.	张春晓, 许建屏, 葛翼鹏, 等. 不同心脏手术风险预测评分系统对中国冠状动脉旁路移植术后患者早期死亡的预测. 中国胸心血管外科临床杂志, 2011, 18(3):194-198.
8.	王崇, 张冠鑫, 韩林, 等. EuroSCORE 模型对心瓣膜手术患者死亡风险的预测. 中国胸心血管外科临床杂志, 2011, 18(3):189-193.
9.	Nashef SA, Roques F, Sharples LD, et al. EuroSCORE Ⅱ. Eur J Cardiothorac Surg, 2012, 41(4):734-744.
10.	Liu ZG, Sun LZ, Chang Q, et al. Should the ‘elephant trunk’ be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection. J Thorac Cardiovasc Surg, 2006, 131(1):107-113.
11.	Sun LZ, Qi RD, Chang Q, et al. Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation:experience with 107 patients. J Thorac Cardiovasc Surg, 2009, 138(6):1358-1362.
12.	Lemeshow S, Hosmer DW Jr. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol, 1982, 115(1):92-106.
13.	Shimamura K, Kuratani, Matsumiya G, et al. Long-term results of the open stent-grafting technique for extended aortic arch disease. J Thorac Cardiovasc Surg, 2008, 135(6):1261-1269.
14.	Zhao M, Stampf S, Valina C, et al. Role of euroSCORE Ⅱ in predicting long-term outcome after percutaneous catheter intervention for coronary triple vessel disease or left main stenosis. Int J Cardiol, 2013, 168(4):3273-3279.
15.	Biancari F, Vasques F, Mikkola R, et al. Validation of EuroSCORE Ⅱ in Patients Undergoing Coronary Artery Bypass Surgery. Ann Thorac Surg, 2012, 93(6):1930-1935.
16.	Gogbashian A, Sedrakyan A, Treasure T. EuroSCORE:a systematic review of international performance. Eur J Cardiothorac Surg, 2004, 25(5):695-700.
17.	Zingone B, Pappalardo A, Dreas L. Logistic versus additive EuroSCORE. A comparative assessment of the two models in an independent population sample. Eur J Cardiothorac Surg, 2004, 26(6):1134-1140.
18.	Karthik S, Srinivasan AK, Grayson AD, et al. Limitations of additive EuroSCORE for measuring risk stratified mortality in combined coronary and valve surgery. Eur J Cardiothorac Surg, 2004, 26(2):318-322.
19.	Hassan A, Anderson C, Kypson A, et al. Clinical outcomes in patients with prolonged intensive care unit length of stay after cardiac surgical procedures. Ann Thorac Surg, 2012, 93(2):565-569.
20.	Mahesh B, Choong CK, Goldsmith K, et al. Prolonged stay in intensive care unit is a powerful predictor of adverse outcomes after cardiac operations. Ann Thorac Surg, 2012, 94(1):109-116.
21.	Ettema RG, Peelen LM, Schuurmans MJ, et al. Prediction models for prolonged intensive care unit stay after cardiac surgery:systematic review and validation study. Circulation, 2010, 122(7):682-689.
22.	Nilsson J, Algotsson L, Höglund P, et al. EuroSCORE predicts intensive care unit stay and costs of open heart surgery. Ann Thorac Surg, 2004, 78(5):1528-1534.
23.	Hoefer D, Ruttmann E, Riha M, et al. Factors influencing intensive care unit length of stay after surgery for acute aortic dissection type A. Ann Thorac Surg, 2002, 73(3):714-718.
24.	Augoustides JG, Pochettino A, Ochroch EA, et al. Clinical predictors for prolonged intensive care unit stay in adults undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest. J Cardiothorac Vasc Anesth, 2006, 20(1):8-13.
25.	Girdauskas E, Kuntze T, Borger MA, et al. Surgical risk of preoperative malperfusion in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2009, 138(6):1363-1369.

1. Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation:a new "standard" therapy for type a dissection involving repair of the aortic arch? Circulation, 2011, 123(9):971-978.
2. Nissinen J, Biancari F, Wistbacka JO, et al. Is it possible to improve the accuracy of EuroSCORE? Eur J Cardiothorac Surg, 2009, 36(5):799-804.
3. Akar AR, Kurtcephe M, Sener E, et al. Validation of the EuroSCORE risk models in Turkish adult cardiac surgical population. Eur J Cardiothorac Surg, 2011, 40(3):730-735.
4. Yap CH, Reid C, Yii M, et al. Validation of the EuroSCORE model in Australia. Eur J Cardiothorac Surg, 2006, 29(4):441-446.
5. Basraon J, Chandrashekhar YS, John R, et al. Comparison of risk scores to estimate perioperative mortality in aortic valve replacement surgery. Ann Thorac Surg, 2011, 92(2):535-540.
6. 葛翼鹏, 许建屏, 孙立忠. 欧洲心脏手术风险评估系统预测中国人心瓣膜手术后并发症的发生及预后. 中国胸心血管外科临床杂志, 2010, 17(5):357-359.
7. 张春晓, 许建屏, 葛翼鹏, 等. 不同心脏手术风险预测评分系统对中国冠状动脉旁路移植术后患者早期死亡的预测. 中国胸心血管外科临床杂志, 2011, 18(3):194-198.
8. 王崇, 张冠鑫, 韩林, 等. EuroSCORE 模型对心瓣膜手术患者死亡风险的预测. 中国胸心血管外科临床杂志, 2011, 18(3):189-193.
9. Nashef SA, Roques F, Sharples LD, et al. EuroSCORE Ⅱ. Eur J Cardiothorac Surg, 2012, 41(4):734-744.
10. Liu ZG, Sun LZ, Chang Q, et al. Should the ‘elephant trunk’ be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection. J Thorac Cardiovasc Surg, 2006, 131(1):107-113.
11. Sun LZ, Qi RD, Chang Q, et al. Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation:experience with 107 patients. J Thorac Cardiovasc Surg, 2009, 138(6):1358-1362.
12. Lemeshow S, Hosmer DW Jr. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol, 1982, 115(1):92-106.
13. Shimamura K, Kuratani, Matsumiya G, et al. Long-term results of the open stent-grafting technique for extended aortic arch disease. J Thorac Cardiovasc Surg, 2008, 135(6):1261-1269.
14. Zhao M, Stampf S, Valina C, et al. Role of euroSCORE Ⅱ in predicting long-term outcome after percutaneous catheter intervention for coronary triple vessel disease or left main stenosis. Int J Cardiol, 2013, 168(4):3273-3279.
15. Biancari F, Vasques F, Mikkola R, et al. Validation of EuroSCORE Ⅱ in Patients Undergoing Coronary Artery Bypass Surgery. Ann Thorac Surg, 2012, 93(6):1930-1935.
16. Gogbashian A, Sedrakyan A, Treasure T. EuroSCORE:a systematic review of international performance. Eur J Cardiothorac Surg, 2004, 25(5):695-700.
17. Zingone B, Pappalardo A, Dreas L. Logistic versus additive EuroSCORE. A comparative assessment of the two models in an independent population sample. Eur J Cardiothorac Surg, 2004, 26(6):1134-1140.
18. Karthik S, Srinivasan AK, Grayson AD, et al. Limitations of additive EuroSCORE for measuring risk stratified mortality in combined coronary and valve surgery. Eur J Cardiothorac Surg, 2004, 26(2):318-322.
19. Hassan A, Anderson C, Kypson A, et al. Clinical outcomes in patients with prolonged intensive care unit length of stay after cardiac surgical procedures. Ann Thorac Surg, 2012, 93(2):565-569.
20. Mahesh B, Choong CK, Goldsmith K, et al. Prolonged stay in intensive care unit is a powerful predictor of adverse outcomes after cardiac operations. Ann Thorac Surg, 2012, 94(1):109-116.
21. Ettema RG, Peelen LM, Schuurmans MJ, et al. Prediction models for prolonged intensive care unit stay after cardiac surgery:systematic review and validation study. Circulation, 2010, 122(7):682-689.
22. Nilsson J, Algotsson L, Höglund P, et al. EuroSCORE predicts intensive care unit stay and costs of open heart surgery. Ann Thorac Surg, 2004, 78(5):1528-1534.
23. Hoefer D, Ruttmann E, Riha M, et al. Factors influencing intensive care unit length of stay after surgery for acute aortic dissection type A. Ann Thorac Surg, 2002, 73(3):714-718.
24. Augoustides JG, Pochettino A, Ochroch EA, et al. Clinical predictors for prolonged intensive care unit stay in adults undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest. J Cardiothorac Vasc Anesth, 2006, 20(1):8-13.
25. Girdauskas E, Kuntze T, Borger MA, et al. Surgical risk of preoperative malperfusion in acute type A aortic dissection. J Thorac Cardiovasc Surg, 2009, 138(6):1363-1369.

Previous Article
腹腔镜胆道探查取石术38例报道
Next Article
腹腔镜胆道探查取石术38例报道

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Validation of European System for Cardiac Operative Risk Evaluation Ⅱ in Predicting the Mortality and Prolonged Intensive Care Unit Stay after Sun's Procedure for Stanford type A Aortic Dissection

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content