Validation of GERAADA score—first step towards quality control in aortic surgery

Berezowski and colleagues present a validation study of the German Registry of Acute Aortic Dissection Type A (GERAADA) score in a US aortic centre [1]. The GERAADA score was developed as a unique tool with a web-based application system for the prediction of 30-day mortality in patients undergoing surgical repair for acute type A aortic dissection (AAD) [2]. Since its first presentation in 2020, the score got externally validated by three European centres with varying results [3–5]. For the first time, the group from the University of Pennsylvania employed the score to a US population being treated in an experienced aortic centre. Data were collected in a remarkably large patient cohort of 689 consecutive patients in a 10-year study period. This highlights the centres’ volume of 50–80 surgically managed AAD being treated by four aortic experts. In previous publications, the vague definition of end-organ malperfusion in the GERAADA score calculation has been topic of discussion. Gemelli et al. therefore addressed this issue and distinguished between ‘clinical’ and ‘radiological’ GERAADA score showing stronger discriminative power in the clinical GERAADA score application. In the Penn Aorta Center study cohort, a very pragmatic a clear definition of preoperative malperfusion—combination of any clinical symptom of organ malperfusion with radiological evidence—was applied. The GERAADA score demonstrated a valid discrimination power with an area under the curve of 0.762 (95% CI 0.703–0.821), similar to the original presentation of the score based on a large GERAADA registry patient cohort [2]. In addition to the validation of the score as practical and easily accessible tool for the prediction of 30-day mortality, authors were able to raise the impact of the score to a next level of utility, potential limitations and future applications.