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. q 2004 Elsevier B.V. All rights reserved.