Risk-stratification in thoracic aortic surgery: should the EuroSCORE be modified?☆

OBJECTIVES: Risk-stratification in cardiac surgical procedures is of major interest. Recent studies have shown, that the EuroSCORE is a very good and reliable risk-stratification score in CABG and in valve surgery. The aim of the study was to evaluate the EuroSCORE in patients undergoing surgery on the thoracic aorta. METHODS: Three hundred and sixty-seven consecutive patients underwent surgery of the thoracic aorta and were scored, according to the additive and logistic EuroSCORE algorithm. We compared correlation of predicted and observed mortality and evaluated a modification of the EuroSCORE in order to improve the scoring system. Score validity was assessed by calculating the area under the receiver operating characteristic curve (ROC). RESULTS: Overall hospital mortality was 10.1%. Additive EuroSCORE predicted mortality was 2.3% for 3-6% risk, 12.9% for 7-8% risk, 18.4% for 9-12% risk and 27.3% for a risk >12%. The modified score predicted mortality was 1% for 3-6% risk, 8.2% for 7-8% risk, 12.1% for 9-14% risk, 18.6% for 15-24% risk and 28.6% for a risk >24%. Area under the ROC-curve was 0.68 for the EuroScore and 0.91 in the modified score, 0.72 and 0.86 in the logistic model. CONCLUSIONS: The modified score, taking into account aortic dissection (6 points) and preoperative malperfusion (12 points) significantly improves the predictive value of the EuroSCORE in patients undergoing thoracic aortic surgery.