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The Model for End-Stage Liver Disease (MELD) score is a widely used tool for quantifying hepatic dysfunction, providing greater accuracy and a wider range of values compared to the Child-Turcotte-Pugh (CTP) score, being also used in prioritizing patients who are eligible for liver transplantation. This study assessed the correlation between the MELD score and the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), a reliable system for categorizing risk levels in patients undergoing cardiovascular surgery. This retrospective study analyzed data from 589 patients who underwent coronary artery bypass grafting (CABG) at the Institute of Cardiovascular Diseases 'Prof. Dr. George I.M. Georgescu' in Iași between January 2011 and December 2020. Data collected included demographical, clinical, biochemical, and intraoperative parameters. The average MELD score was 6.09 ± 4.1 (median = 5.72), and the average EuroSCORE II was 6.28 ± 8 (median = 3.85). A significant but relatively modest positive relationship was found between the MELD score and EuroSCORE II, with a correlation coefficient of 0.23 and a corresponding significance level of 0.001. This study demonstrates a positive correlation between MELD and Euro- SCORE II in patients who underwent CABG. Incorporating the MELD score into the preoperative risk assessment of cardiac surgery patients could help identify high-risk individuals and guide clinical decision-making. [ABSTRACT FROM AUTHOR]

Background: Pulmonary artery catheter (PAC) is a diagnostic and haemodynamic monitoring tool. The PAC is used by clinicians in adult medical ICUs, cardiac catheterization laboratories and coronary care units (CCUs). Objective: To determine the indications for the use of pulmonary artery catheter (PAC) in patients undergoing cardiac surgery and to study the outcome of patients with PAC undergoing cardiac surgery. Methods: The present study was carried out in Department of Anesthesiology, Narayana Hrudayalaya, Bangalore. In our study 1000 patients with PAC were assessed retrospectively and data of patients was collected from 2017-2019. EuroSCORE of patients was calculated to assess preoperative condition of the patient prior to surgery. Results: Data of one thousand patients with PAC was collected. The following observations were seen. 71.5% patients were of age <60 years. 77.8% patients were males, and 22.8% patients were female. The most common indication for PAC insertion was PAH (pulmonary artery hypertension) (37.2%), followed by hemodynamic monitoring (33.2%), followed by heart failure with reduced ejection fraction (low EF) (24.3%), hypertrophic obstructive cardiomyopathy (HOCM) (3.1%), severe right ventricular (RV) dysfunction (1.0%), ventricular assist device (VAD) & cardiac transplant (0.8%), others (0.4%). During PAC insertion 0.5% patients developed transient cardiac arrhythmia, 0.2% patients had mild bleeding at insertion site. Postoperative data analysis showed that in patients with PAC post op 23.5% required IABP, 13.9% had cardiac arrest, death (12.9%), stroke (5%), septicemia (4.1%). Among patient with (EuroSCORE 1-3, n=188), (EuroSCORE 4-6, n=529), (EuroSCORE 7-10, n=212), (EuroSCORE >10, n=55); ICU stay was >10 days in 15.4%, 16.44%, 20.75%, 60% respectively with p<0.001. Hospital stay was 10 ±5days in 47.3 % cases, 23 ± 7days among 38.5% patients, 38 ± 7 among 14.8% patients, 53 ± 7days among 0.4% patients and 75 ± 14.5among 0.3% patients. Conclusion: PAC is an important tool to monitor continuous cardiac output, systemic vascular resistance, pulmonary artery pressure. Use of PAC has shown to guide appropriate vasopressor and ionodilator therapy. Our study showed 0.7 % complications during procedure which were reversible and could be managed conservatively. Patient with high EuroSCORE and severe cardiac dysfunction had higher mortality, and hence mortality cannot be directly attributed to PAC. [ABSTRACT FROM AUTHOR]

Risk prediction models are an important part of assessing operative mortality and postoperative complication rates in current cardiac surgery practice. Furthermore, they guide clinical decision-making and perioperative patient management. In recent years, a variety of clinical prediction models have been developed in China and other countries to assess the risk of mortality and complications after cardiac surgery. Currently, the most widely used and mature models are the new version of the European Cardiac Surgery Evaluation System (EuroSCORE II), the American Society of Thoracic Surgeons Cardiac Surgery Risk Model (STS score), and the Chinese Coronary Artery Bypass Graft Surgery Risk Evaluation System (SinoSCORE). This article reviews the application of these three risk prediction models, to identify the optimal model for guiding clinical practice. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Prognostic models are widely used across medicine and within cardiothoracic surgery, where predictive tools such as EuroSCORE are commonplace. Such models are a useful component of clinical assessment but may be misapplied. In this article, we demonstrate some of the major issues with risk scores by using the popular BBC television programme Strictly Come Dancing (known as Dancing with the Stars in many other countries) as an example. METHODS We generated a multivariable prognostic model using data from the then-completed 19 series of Strictly Come Dancing to predict prospectively the results of the 20th series. RESULTS The initial model based solely on demographic data was limited in its predictive value (0.25, 0.22; R 2 and Spearman's rank correlation, respectively) but was substantially improved following the introduction of early judges' scores deemed representative of whether contestants could actually dance (0.40, 0.30). We then utilize our model to discuss the difficulties and pitfalls in using and interpreting prognostic models in cardiothoracic surgery and beyond, particularly where these do not adequately capture potentially important prognostic information. CONCLUSION Researchers and clinicians alike should use prognostic models cautiously and not extrapolate conclusions from demographic data alone. [ABSTRACT FROM AUTHOR]

Abstract Background Traditional risk stratification tools do not describe the complex principle determinant relationships that exist amongst pre-operative and peri-operative factors and their influence on cardiac surgical outcomes. This paper reports on the use of Bayesian networks to investigate such outcomes. Methods Data were prospectively collected from 4776 adult patients undergoing cardiac surgery at a single UK institute between April 2012 and May 2019. Machine learning techniques were used to construct Bayesian networks for four key short-term outcomes including death, stroke and renal failure. Results Duration of operation was the most important determinant of death irrespective of EuroSCORE. Duration of cardiopulmonary bypass was the most important determinant of re-operation for bleeding. EuroSCORE was predictive of new renal replacement therapy but not mortality. Conclusions Machine-learning algorithms have allowed us to analyse the significance of dynamic processes that occur between pre-operative and peri-operative elements. Length of procedure and duration of cardiopulmonary bypass predicted mortality and morbidity in patients undergoing cardiac surgery in the UK. Bayesian networks can be used to explore potential principle determinant mechanisms underlying outcomes and be used to help develop future risk models.

Abstract Background To determine the discriminative accuracy and calibration of EuroSCORE II in relation to age, sex, and surgical risk in a large nationwide coronary artery bypass grafting (CABG) cohort. Methods All 14,118 patients undergoing isolated CABG in Sweden during 2012–2017 were included. Individual patient data were taken from the SWEDEHEART registry. Patients were divided by age ( 8%). Discriminative accuracy was determined by the area under the receiver operating characteristic curve (AUC) and calibration by the observed/estimated (O/E) mortality ratio at 30 days. Results AUC and O/E ratio were 0.82 (95% CI 0.79–0.85) and 0.58 (0.50–0.66) overall, 0.82 (0.79–0.86) and 0.57 (0.48–0.66) in men, and 0.79 (0.73–0.85) and 0.60 (0.47–0.75) in women. Regarding age, discriminative accuracy was highest in patients aged 60–69 years (AUC: 0.86 [0.80–0.93]) but was satisfactory in all groups (AUC: 0.74–0.80). O/E ratio varied from 0.26 for patients > 60 years to 0.90 for patients > 80 years. Regarding surgical risk, AUC and O/E ratio were 0.63 (0.44–0.83) and 0.18 (0.09–0.30) in low-risk patients, 0.60 (0.55–0.66) and 0.57 (0.46–0.68) in intermediate-risk patients, and 0.78 (0.73–0.83) and 0.78 (0.64–0.92) in high-risk patients. Conclusions EuroSCORE II had good discriminative accuracy independently of sex and age, but markedly overestimated mortality risk, especially in younger patients. Accuracy and calibration were better in high-risk patients than in low-risk and intermediate-risk patients.

OBJECTIVES: Previous studies indicated higher long-term mortality after the transfusion of allogeneic red blood cells (RBC); newer recommendations emphasize lower transfusion rates. The consequences of the transfusion of RBCs in cardiac surgery are unclear because later studies focused on transfusion triggers and short-term outcomes. Reports on long-term complications after cardiac surgery are few. MATERIAL AND METHODS: The mandatory Western Denmark Heart Registry was used to identify all adult cardiac operations performed in 4 centres from 2000 to 2019. Patients with multiple entries or previous cardiac operations, special/complex procedures, dying within 30 days and not eligible for follow-up were excluded. RESULTS: A total of 32,581 adult cardiac operations performed in 4 centres from 2000 to 2019 were included. The Kaplan–Meier survival plot for low-risk patients undergoing simple cardiac operations showed a significantly lower 15-year survival (0.384 vs 0.661) of patients who received perioperative RBC transfusions [odds ratio 2.43 (confidence level 2.23–2.66)]. The risk decreased with increasing comorbidity or age. No difference was found in high-risk patients. The adjusted risk ratio after an RBC transfusion, including age, sex, comorbidity and surgery, was 1.62 (1.48–1.77). CONCLUSIONS: Despite reduced transfusion rates, long-term follow-up on especially low-risk patients undergoing comparable cardiac operations still demonstrates substantially more deaths of patients receiving perioperative RBC transfusions. Even transfusion of 1–2 units is associated with increased long-term mortality. In 2012, we published a large register-based study demonstrating a clear association between transfusion with allogeneic red blood cells (RBCs) and higher long-term mortality in patients undergoing cardiac surgery [1]. [ABSTRACT FROM AUTHOR]

Background: Traditional risk stratification tools do not describe the complex principle determinant relationships that exist amongst pre-operative and peri-operative factors and their influence on cardiac surgical outcomes. This paper reports on the use of Bayesian networks to investigate such outcomes. Methods: Data were prospectively collected from 4776 adult patients undergoing cardiac surgery at a single UK institute between April 2012 and May 2019. Machine learning techniques were used to construct Bayesian networks for four key short-term outcomes including death, stroke and renal failure. Results: Duration of operation was the most important determinant of death irrespective of EuroSCORE. Duration of cardiopulmonary bypass was the most important determinant of re-operation for bleeding. EuroSCORE was predictive of new renal replacement therapy but not mortality. Conclusions: Machine-learning algorithms have allowed us to analyse the significance of dynamic processes that occur between pre-operative and peri-operative elements. Length of procedure and duration of cardiopulmonary bypass predicted mortality and morbidity in patients undergoing cardiac surgery in the UK. Bayesian networks can be used to explore potential principle determinant mechanisms underlying outcomes and be used to help develop future risk models. [ABSTRACT FROM AUTHOR]

Background: To determine the discriminative accuracy and calibration of EuroSCORE II in relation to age, sex, and surgical risk in a large nationwide coronary artery bypass grafting (CABG) cohort. Methods: All 14,118 patients undergoing isolated CABG in Sweden during 2012–2017 were included. Individual patient data were taken from the SWEDEHEART registry. Patients were divided by age (< 60, 60–69, 70–79, ≥ 80 years), sex, and surgical risk (low: EuroSCORE < 4%, intermediate: 4–8%, high: > 8%). Discriminative accuracy was determined by the area under the receiver operating characteristic curve (AUC) and calibration by the observed/estimated (O/E) mortality ratio at 30 days. Results: AUC and O/E ratio were 0.82 (95% CI 0.79–0.85) and 0.58 (0.50–0.66) overall, 0.82 (0.79–0.86) and 0.57 (0.48–0.66) in men, and 0.79 (0.73–0.85) and 0.60 (0.47–0.75) in women. Regarding age, discriminative accuracy was highest in patients aged 60–69 years (AUC: 0.86 [0.80–0.93]) but was satisfactory in all groups (AUC: 0.74–0.80). O/E ratio varied from 0.26 for patients > 60 years to 0.90 for patients > 80 years. Regarding surgical risk, AUC and O/E ratio were 0.63 (0.44–0.83) and 0.18 (0.09–0.30) in low-risk patients, 0.60 (0.55–0.66) and 0.57 (0.46–0.68) in intermediate-risk patients, and 0.78 (0.73–0.83) and 0.78 (0.64–0.92) in high-risk patients. Conclusions: EuroSCORE II had good discriminative accuracy independently of sex and age, but markedly overestimated mortality risk, especially in younger patients. Accuracy and calibration were better in high-risk patients than in low-risk and intermediate-risk patients. [ABSTRACT FROM AUTHOR]

Abstract Background Reimbursement for cardiac surgical procedures in Israel is uniform and does not account for diversity in costs of various procedures or for diversity in patient mix. In an era of new and costly technology coupled with higher risk patients needing more complex surgery, these tariffs may not adequately reflect the true financial burden on the caregivers. In the present study we attempt to determine whether case mix and complexity of procedures significantly affect cost to justify differential tariffs. Methods We included all patients undergoing cardiac surgery at Shaare Zedek Medical Center between the years 1993–2016. Patients were stratified according to (1) type of surgery and (2) clinical profile as reflected by the predicted operative risk according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Approximate cost of each group of patients was estimated by the average number of days in the Intensive Care Unit and days in the postoperative ward multiplied by the respective daily costs as determined by the Ministry of Health. We then added the fixed cost of the components used in the operating room (manpower and disposables). The final estimated cost (the outcome variable) was then evaluated as it relates to type of surgery and clinical profile. ANOVA was used to analyze cost variability between groups, and backward regression analysis to determine the respective effect of the abovementioned variables on cost. Because of non-normal distribution, both costs and lengths of stay were Log-transformed. Results Altogether there were 5496 patients: 3863, 836, 685 and 112 in the isolated CABG, CABG + valve, 1 valve and 2 valves replacement groups. By ANOVA, the costs in all EuroSCORE subgroups were significantly different from each other, increasing with increased EuroSCORE subgroup. Cost was also significantly different among procedure groups, increasing from simple CABG to single valve surgery to CABG + valve surgery to 2-valve surgery. In backward stepwise multiple regression analysis, both type of procedure and EuroSCORE group significantly impacted cost. ICU stay and Ward stay were significantly but weakly related while EuroSCORE subgroup was highly predictive of both ICU stay and ward stay. Conclusions The cost of performing heart surgery today is directly influenced by both patient profile as well as type of surgery, both of which can be quantified. Modern day technology is costly yet has become mandatory. Thus reimbursement for heart surgery should be based on differential criteria, namely clinical risk profile as well as type of surgery. Our results suggest an urgent need for design and implementation of a differential tariff model in the Israeli reimbursement system. We suggest that a model using a fixed, average price according to the type of procedure costs, in addition to a variable hospitalization cost (ICU + ward) determined by the patient EuroSCORE or EuroSCORE subgroup should enable an equitable reimbursement to hospitals, based on their case mix.

Objectives: Cardiac surgery has evolved significantly since the turn of the century. The objective of this study was to investigate trends in cardiac surgery activity and outcomes in the United Kingdom utilizing a mandatory national cardiac surgical clinical database in the context of a comprehensive public health care system (ie, the UK National Health Service). Methods: Data for all cardiac surgery procedures performed between 2002 and 2016 were extracted from the UK National Adult Cardiac Surgery Audit database. Data are validated and cleaned using reproducible algorithms. Trends in activity and outcomes were analyzed by fiscal year using linear regression. Results: A total of 534,067 procedures were performed during the study period with the number of cases per year peaking in 2008/2009 at 41,426. Despite an increase in patient age and mean logistic European System for Cardiac Operative Risk Evaluation score, the in-hospital mortality rate for all cardiac surgery has fallen from 4.0% to 2.8% (P

Background and Aims: The isolated tricuspid valve surgery is performed using beating or arrested heart surgery. The present study aimed to evaluate and compare the results of patients who underwent isolated tricuspid valve surgery using the beating and arrested heart techniques. Methods: In this retrospective observational study, all patients undergoing isolated tricuspid valve surgery between 2011 and 2018 were included. The patient's demographic information, echocardiographic, surgery, and hospitalization results were collected, and the EuroSCORE was calculated from the patient's medical records. Results: Fifty‐three patients were included in the study of which 21 (39.63%) and 32 (60.37%) underwent a beating heart and arrested heart surgeries, respectively. There were no significant differences between the two studied groups in the echocardiographic results before and after the surgery, total hospitalization days (p = 0.56), and the mortality in the first 30 days after the surgery (p = 0.152). However, the duration of surgery (p < 0.001), EuroSCORE (p = 0.005), and patients who underwent lateral thoracotomy (p = 0.007) were notably lower in the arrested heart than in the beating heart group. In contrast, the duration of cardiopulmonary bypass and hospitalization in an intensive care unit after the surgery was remarkably lower in the beating heart than in the arrested heart group (p < 0.001 for both cases). Conclusion: Although there were some significant differences between the two kinds of surgery techniques, it seems superficial that made a particular decision to consider each method's superiority. Therefore, further studies with larger populations and meta‐analyses are required to recommend the preferred method for the surgeons certainly. [ABSTRACT FROM AUTHOR]

Abstract Background and Aims The isolated tricuspid valve surgery is performed using beating or arrested heart surgery. The present study aimed to evaluate and compare the results of patients who underwent isolated tricuspid valve surgery using the beating and arrested heart techniques. Methods In this retrospective observational study, all patients undergoing isolated tricuspid valve surgery between 2011 and 2018 were included. The patient's demographic information, echocardiographic, surgery, and hospitalization results were collected, and the EuroSCORE was calculated from the patient's medical records. Results Fifty‐three patients were included in the study of which 21 (39.63%) and 32 (60.37%) underwent a beating heart and arrested heart surgeries, respectively. There were no significant differences between the two studied groups in the echocardiographic results before and after the surgery, total hospitalization days (p = 0.56), and the mortality in the first 30 days after the surgery (p = 0.152). However, the duration of surgery (p

Abstract Background Despite modern advances in intensive care medicine and surgical techniques, mortality rates in cardiac surgical patients are still about 3%. Considerable efforts were made to predict morbidity and mortality after cardiac surgery. In this study, we analysed the predictive properties of EuroScore and IL-6 for mortality in ICU, prolonged postoperative mechanical ventilation, and prolonged stay in ICU. Methods We enrolled 2972 patients undergoing cardiac surgery. The patients either underwent aortic valve surgery (AV), mitral valve surgery (MV), coronary artery bypass grafting (CABG), and combined operations of aortic valve and coronary artery bypass grafting (AV + CABG) or of mitral and tricuspid valve (MV + TV). Different laboratory and clinical parameters were analysed. Results EuroScore as well as IL-6 were associated with increased mortality after cardiac surgery. Furthermore, a higher EuroScore and elevated levels of IL-6 were predictors for prolonged mechanical ventilation and a longer stay in ICU. Especially, highly significant elevated IL-6 levels and an increased EuroScore showed a strong association. Statistics suggested superiority when both parameters were combined in a single model. Conclusion Our results suggest that EuroScore and IL-6 are helpful in predicting the course in ICU after cardiac surgery, and therefore, the use of intensive care resources. Especially, the combination of highly elevated levels of IL-6 and EuroScore may prove to be excellent predictors for an unfortunate postoperative course in ICU.

Aim: We developed a machine learning model using EuroScore assumptions and preoperative and intraoperative risk factors to predict mortality after coronary artery bypass graft (CABG). Materials & methods: We retrospectively examined data from 108 CABG patients at King Abdullah University Hospital, classifying them into risk groups via EuroScore and predicting mortality through random forest classification. Results: High-risk patients displayed longer surgical times and significant factors such as age and surgery choice. The median EuroScore was 0.95 (0.5-6.4). The model yielded high AUC scores (0.98, 0.95) indicating strong predictive accuracy. Conclusion: Our findings showed that the machine learning models combined with the EuroScore significantly improve post-CABG mortality prediction. For further validation, larger datasets are needed.

Aortic valve stenosis (AS) is the third most frequent cardiovascular abnormality after coronary artery disease and hypertension. A bicuspid aortic valve is the most common cause for AS until seventh decade and calcific valve degeneration is responsible thereafter. In symptomatic patients, The risk of death increases from ≤1%/year to 2%/month. An echo valve area ≤1 cm2, peak transaortic velocity ≥4 m/s, mean valve gradient ≥40 mmHg and/or computerized tomography valve calcium score >2000 Agatston units (AU) for males or more than 1200 AU for females indicate severe AS. AS stages and management are discussed. Valve replacement is based on surgical risk, valve durability/hemodynamics, need for anticoagulation and patient preferences. EuroSCORE ≥20%, Society of Thoracic Surgeons Predicted Risk of Mortality ≥8% and co-morbidities indicate high surgical risk. Surgery is recommended for low-intermediate risk patients. Transcatheter aortic valve implantation is an alternative in older patients at low, intermediate, high or prohibitive risk. Transaortic valve implantation/replacement trials are summarized. The aortic valve is one of the four valves within the heart. Aortic valve stenosis is a problem that can occur in middle age and elderly people and limits the amount of oxygen-rich blood that can be pumped by the heart to the tissues of the body. Aortic valve stenosis can cause symptoms such as shortness of breath, chest discomfort, dizziness, fainting and difficulty exercising. Treatment consists of replacement of the aortic valve with a mechanical, pig or cow valve during open heart surgery. Alternatively, a catheter (tube) with a tissue valve can be passed through a peripheral artery into the heart for placement of a new aortic valve. The catheter valve replacement option has significantly reduced the side effects and death rate of patients who undergo aortic valve replacement for aortic valve stenosis. [ABSTRACT FROM AUTHOR]

Ischemic heart disease still remains one of the leading causes) of morbidity and mortality of population of high-developed countries. Annually we notice an increase of coronary artery bypass grafting (CABG) procedures, especially for high-risk patients. Objective. To perform literature review of CABG for high-risk patients. Results. According to literature data’s we reviewed and compared risks scores used in cardiovascular surgery for determination of patients’ severity and probability of death. The basic errors of the EuroSCORE I, II scales and the possibilities of their use in minimally invasive surgery were identified. According to modern randomized clinical trials (RCTs) comparing the OPCAB (off-pump coronary artery bypass (OPCAB) and ONCAB (on-pump coronary artery bypass) techniques, there is no clear difference in complications. Despite the small percentage of high-risk patients in RCTs (18% in the CORONARY trial), many authors consider that OPCAB has a lot of advantages for high-risk patients. Better results were obtained in elderly patients with neurocognitive disorders, porcelain aorta, diabetes mellitus, kidney insufficiency and low ejection fraction of left ventricle. Kowalewski et al. studied high-risk patients and used special statistical methods to compare patients by their risk profile. They concluded that high-risk patients have linear correlation between risk profile and increase in benefits from OPCAB: all-cause mortality (P

Background: Reimbursement for cardiac surgical procedures in Israel is uniform and does not account for diversity in costs of various procedures or for diversity in patient mix. In an era of new and costly technology coupled with higher risk patients needing more complex surgery, these tariffs may not adequately reflect the true financial burden on the caregivers. In the present study we attempt to determine whether case mix and complexity of procedures significantly affect cost to justify differential tariffs. Methods: We included all patients undergoing cardiac surgery at Shaare Zedek Medical Center between the years 1993–2016. Patients were stratified according to (1) type of surgery and (2) clinical profile as reflected by the predicted operative risk according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Approximate cost of each group of patients was estimated by the average number of days in the Intensive Care Unit and days in the postoperative ward multiplied by the respective daily costs as determined by the Ministry of Health. We then added the fixed cost of the components used in the operating room (manpower and disposables). The final estimated cost (the outcome variable) was then evaluated as it relates to type of surgery and clinical profile. ANOVA was used to analyze cost variability between groups, and backward regression analysis to determine the respective effect of the abovementioned variables on cost. Because of non-normal distribution, both costs and lengths of stay were Log-transformed. Results: Altogether there were 5496 patients: 3863, 836, 685 and 112 in the isolated CABG, CABG + valve, 1 valve and 2 valves replacement groups. By ANOVA, the costs in all EuroSCORE subgroups were significantly different from each other, increasing with increased EuroSCORE subgroup. Cost was also significantly different among procedure groups, increasing from simple CABG to single valve surgery to CABG + valve surgery to 2-valve surgery. In backward stepwise multiple regression analysis, both type of procedure and EuroSCORE group significantly impacted cost. ICU stay and Ward stay were significantly but weakly related while EuroSCORE subgroup was highly predictive of both ICU stay and ward stay. Conclusions: The cost of performing heart surgery today is directly influenced by both patient profile as well as type of surgery, both of which can be quantified. Modern day technology is costly yet has become mandatory. Thus reimbursement for heart surgery should be based on differential criteria, namely clinical risk profile as well as type of surgery. Our results suggest an urgent need for design and implementation of a differential tariff model in the Israeli reimbursement system. We suggest that a model using a fixed, average price according to the type of procedure costs, in addition to a variable hospitalization cost (ICU + ward) determined by the patient EuroSCORE or EuroSCORE subgroup should enable an equitable reimbursement to hospitals, based on their case mix. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES The commonly used cardiac surgery risk scores, European System for Cardiac Operative Risk Evaluation II and Society of Thoracic Surgeons score, are inaccurate in predicting mortality in the ageing patient population and do not include the biological age. This requests a need for a new risk score incorporating frailty. The aim of this study was to compare the prediction of mortality and the additive effect of comprehensive assessment of frailty score and the shortened version, frailty predicts death one year after elective cardiac surgery test on the existing risk scores. METHODS Six hundred four patients undergoing cardiac surgery and aged ≥65 years were included in this prospective observational study. These frailty scores are based on minor physical tests. We compared these frailty score predictions of mortality and their added value to the existing risk scores evaluated by concordance-statistics (C -statistics), integrated discrimination improvement and net reclassification improvement. RESULTS The median age was 73 years (21% female). C -statistics showed that comprehensive assessment of frailty score with a value of 0.69, frailty predicts death one year after elective cardiac surgery test 0.68, Society of Thoracic Surgeons score 0.70 and European System for Cardiac Operative Risk Evaluation 0.64. Frailty assessment, added to the existing risk scores, significantly improved integrated discrimination improvement up to 0.05, and net reclassification improvement up to 0.04. Frailty assessment also increased the C -statistics, but this did not reach statistical significance. CONCLUSIONS Frailty scores are as good as the existing risk scores for the prediction of mortality in patients undergoing cardiac surgery. Added to the existing scores, frailty assessment improves the C -statistics and integrated discrimination improvement over time. Clinical trials registration number NCT02992587 [ABSTRACT FROM AUTHOR]

Introduction: The aim of our study was to evaluate the performance of the European Cardiac Operative Risk Assessment System (EuroSCORE) in predicting mortality in elderly patients aged 70 years and older undergoing elective cardiovascular surgery. Material and methods: The hospital data of 112 patients aged 70 years and older who underwent elective cardiovascular surgery procedures at a state hospital clinic in Turkey were scanned retrospectively. The demographic, medical, surgical, and postoperative information and risk factors for the patients were recorded and evaluated. The patients were divided into 3 groups according to the EuroSCORE system. In-hospital death was defined as the end-point of the study. Results: The overall mortality was 5.35%. 28.57% of the patients were in the low-risk group, whereas the rates in the medium- and high-risk groups were 61.60% and 9.83%, respectively. The mean EuroSCORE was 5.33 ± 2.50 in the deceased group and 3.17 ± 1.90 in the surviving patient group (p = 0.0093). The number of observed predicted deceased cases did not differ between different risk groups (p = 0.23). The area under curve (AUC) for the EuroSCORE was 0.932 ± 0.019; p < 0.0001, with a 95% CI of 0.8950-0.9704. Conclusions: The AUC for the EuroSCORE in our cases was higher than the reported articles with a similar age group. We suggest that the EuroSCORE assessed operative risk in octogenarians with significantly high efficiency. [ABSTRACT FROM AUTHOR]

Background: The lack of reliable data on the possibility, safety and results of OPCABG in patients with high surgical risk hinders the further wide introduction into clinical practice of such operations. In this regard, conducting a comparative evaluation of the results of OPCABG in patients with low and high surgical risk seems to us a worthwhile project. Materials and Methods: During the period between 2015 and 2017, 310 OPCABG operations were performed. Patients were divided into 2 groups depending on the EuroSCORE risk calculator value. Group 1 consisted of 130(41.9%) patients with a high surgical risk (EuroSCORE≥5), and Group 2 consisted of 180(58.1%) patients with a low surgical risk (EuroSCORE

Objective: We aimed to define the relationship of preoperative N-terminal-pro-brain type natriuretic peptide (NT-pro-BNP) testing in routine practice of cardiac surgery with clinical, perioperative variables, surgical outcomes and complications in pediatric and adult cardiac surgery patients. In addition, we assessed relationship of NT-pro-BNP with EuroSCORE II in adult patients undergoing cardiac surgery. Methods: A total of 48 patients who underwent cardiac surgery in our institution were enrolled into this retrospective observational cohort study. According to age aspects pediatric (PG, n=20) and adult (AG, n=28) group of patients were separately evaluated. Each group further was categorized into two subgroups (group 1 and 2) on the basis of cut-off points of NT-pro-BNP level (430 and 250pg/ml in adults and children, respectively). Preoperative NT-pro- BNP was obtained from patients. Statistical tests were conducted to reveal differences in clinical and perioperative variables among NT-pro-BNP groups and relationship of the assay with baseline clinical and operative parameters, as well as postoperative outcomes. Results: In adults undergoing cardiac surgery, statistically significant differences were found between groups with low and high levels of NT-pro-BNP by NYHA classes (I to III, p˂0.001), body mass index (BMI) values (mean (SD) -31.7(3.15) vs 25.9 (3.8) kg/cm2, p=0.017), estimated glomerular filtration rate (eGFR) (111.4 (26.4) vs 77.9 (22.4) ml/min/1.73m2, p=0.036), moderately impaired renal function (20% vs 72.7%, p=0.049), need for inotropes (28.6% vs 86.7%, p=0.006), and mean EuroSCORE II (0.81 (0.19) vs 1.7 (0.5), p=0.008). There was the positive significant correlation of NT-pro-BNP levels with EuroSCORE II, NYHA class, need for inotropes, renal function and left ventricular (LV) function categories, while its negative correlation was found with BMI, LV ejection fraction and eGFR parameters. In PG – NT-pro-BNP was negatively correlated with age, body surface area, LV end-diastolic and end-systolic dimensions. Conclusion: In adult patients undergoing cardiac surgery, preoperative NT-pro-BNP level correlated well with several baseline and clinical-operative parameters, including BMI, renal and LV function, NYHA class, need for inotropes support, and EuroSCORE II. Further studies are needed to define its exact diagnostic and prognostic significance in pediatric patients.

Background: Despite modern advances in intensive care medicine and surgical techniques, mortality rates in cardiac surgical patients are still about 3%. Considerable efforts were made to predict morbidity and mortality after cardiac surgery. In this study, we analysed the predictive properties of EuroScore and IL-6 for mortality in ICU, prolonged postoperative mechanical ventilation, and prolonged stay in ICU. Methods: We enrolled 2972 patients undergoing cardiac surgery. The patients either underwent aortic valve surgery (AV), mitral valve surgery (MV), coronary artery bypass grafting (CABG), and combined operations of aortic valve and coronary artery bypass grafting (AV + CABG) or of mitral and tricuspid valve (MV + TV). Different laboratory and clinical parameters were analysed. Results: EuroScore as well as IL-6 were associated with increased mortality after cardiac surgery. Furthermore, a higher EuroScore and elevated levels of IL-6 were predictors for prolonged mechanical ventilation and a longer stay in ICU. Especially, highly significant elevated IL-6 levels and an increased EuroScore showed a strong association. Statistics suggested superiority when both parameters were combined in a single model. Conclusion: Our results suggest that EuroScore and IL-6 are helpful in predicting the course in ICU after cardiac surgery, and therefore, the use of intensive care resources. Especially, the combination of highly elevated levels of IL-6 and EuroScore may prove to be excellent predictors for an unfortunate postoperative course in ICU. [ABSTRACT FROM AUTHOR]

Objective: This study was planned to evaluate effectiveness of cardiac surgery score (CASUS) system used for the prediction of mortality after the cardiac surgery and to compare it with EuroSCORE, a tested and approved method. Method: Fifty patients over the age of 18 who came to the intensive care unit (ICU) after open heart surgery and stayed in the ICU for more than 48 hours were prospectively included in the study. After the preoperative EuroSCORE evaluation of the patients, CASUS scoring systems were used for risk scoring from postoperative 0 day to the service or up to the 6th postoperative day (or possible mortality) in patients whose stay in ICU was prolonged. We evaluated the place of both models in the prediction of ICU mortality. Results: The study was conducted with 50 patients- 21 female, 29 male-, aged between 19 and 79 years (mean age: 60.38±12.50). Five (10%) cases exited.The areas under the ROC curve were estimated as follows: EuroSCORE, 45.3%; and for CASUS 0,1, and 2. day scores AUCs of ROC curve were 66,9%, 64,7%, and 79,8%, respectively. The CASUS 2nd day score was found to be valuable in predicting mortality (p<0.01). A statistically significant relationship was observed between the days of stay in the ICU and mortality. Conclusion: Our results show that the rate of the accurate prediction of mortality of CASUS is insufficient on postop 0th and 1st day; however CASUS score on postoperative 2nd day has sufficient.predictive accuracy EuroSCORE is not found effective in the prediction of mortality. It is observed that if the duration of stay in ICU is prolonged, it statistically significantly increases the risk of mortality. [ABSTRACT FROM AUTHOR]

Background: Surgical risk prediction models are routinely used to guide decision-making for transcatheter aortic valve replacement (TAVR). New and updated TAVR-specific models have been developed to improve risk stratification; however, the best option remains unknown. Objective: To perform a comparative validation study of six risk models for the prediction of 30-day mortality in TAVR Methods and results: A total of 2946 patients undergoing transfemoral (TF, n = 2625) or transapical (TA, n = 321) TAVR from 2008 to 2018 from the German Rhine Transregio Aortic Diseases cohort were included. Six surgical and TAVR-specific risk scoring models (LogES I, ES II, STS PROM, FRANCE-2, OBSERVANT, GAVS-II) were evaluated for the prediction of 30-day mortality. Observed 30-day mortality was 3.7% (TF 3.2%; TA 7.5%), mean 30-day mortality risk prediction varied from 5.8 ± 5.0% (OBSERVANT) to 23.4 ± 15.9% (LogES I). Discrimination performance (ROC analysis, c-indices) ranged from 0.60 (OBSERVANT) to 0.67 (STS PROM), without significant differences between models, between TF or TA approach or over time. STS PROM discriminated numerically best in TF TAVR (c-index 0.66; range of c-indices 0.60 to 0.66); performance was very similar in TA TAVR (LogES I, ES II, FRANCE-2 and GAVS-II all with c-index 0.67). Regarding calibration, all risk scoring models—especially LogES I—overestimated mortality risk, especially in high-risk patients. Conclusions: Surgical as well as TAVR-specific risk scoring models showed mediocre performance in prediction of 30-day mortality risk for TAVR in the German Rhine Transregio Aortic Diseases cohort. Development of new or updated risk models is necessary to improve risk stratification. [ABSTRACT FROM AUTHOR]

Introduction. Cardiac Surgery Score (CASUS) was introduced in 2005 as the first postoperative scoring system specific for patients who had cardiac surgery. Prior to this, European System for Cardiac Operative Risk Evaluation (EuroSCORE) has been used preoperatively, while Intensive Care National Audit and Research Centre Score (ICNARC) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, which are widely used in general intensive care unit population, have been used to score cardiac patients postoperatively. The development of CASUS by Hekmat and colleagues for use in postoperative cardiac patients aims to change this. We wanted to validate CASUS against the well-established preoperative Logistic EuroSCORE, and postoperative APACHE II and ICNARC scores. Method. Institutional approval for this study was granted by the Audit and Clinical Governance Committee. We analyzed prospectively collected data of patients who had cardiac surgery in Castle Hill Hospital between January 2016 and September 2018. All patients who underwent surgery in the unit would have had Logistic EuroSCORE, APACHE, and ICNARC scores calculated as standard. CASUS was then calculated for these patients based on their day 1 postoperative variables. The scoring systems were compared and data presented as area under the receiver operating characteristic curve. Result. Our study shows that CASUS is the best predictor of mortality followed by ICNARC, Logistic EuroSCORE, and APACHE II. ICNARC score remains the most accurate predictor of renal and pulmonary complication followed by CASUS. Conclusion. CASUS is a useful scoring system in post-cardiac surgery patients. The accuracy of CASUS and ICNARC scores in predicting mortality, pulmonary, and renal complications are comparable. [ABSTRACT FROM AUTHOR]

Introduction European System for Cardiac Operative Risk Evaluation (EuroSCORE) is the standard tool for risk stratification of patients undergoing cardiac surgery. Its relevance has been validated in European, Asian countries and also in Nepal. Its limitations led to development of EuroSCORE II. This study was carried out to compare EuroSCORE II with EuroSCORE in Nepalese cardiac surgical patients. Methods A retrospective analytical cohort study of 3 years duration in 972 adult cardiac surgeries was conducted. Scores obtained from EuroSCORE (Logistic and Additive) and EuroSCORE II was compared with the observed mortality. Calibration was calculated by Hosmer- Lemeshow (H-L) test (Chi Square test) and discrimination by calculating the area under the curve (AUC) of receiver operating characteristics (ROC) curve. Results Observed mortality was 4.11%. EuroSCORE additive, logistic and EuroSCORE II predicted mortality were 4.32%, 4.55% and 2.13% respectively. H-L chi square calculation for EuroSCORE additive model could not hold as all observed and expected frequencies match exactly. Hence it can be considered as a good fit. EuroSCORE logistic model (H-L, Chi-square 7.743, p<0.001) and EuroSCORE II (H-L, Chi-square 11.631, p = 0.168) also showed good fit i.e. both can predict mortality satisfactorily. AUC of ROC curve of EuroSCORE additive, logistic and EuroSCORE II were 0.632, 0.636 and 0.616 respectively, which showed fair discrimination power. Conclusion Mortality prediction of adult cardiac surgical patients by EuroSCORE (additive and logistic) and EuroSCORE II was satisfactory. [ABSTRACT FROM AUTHOR]

Background: The Additive Euroscore (AE) predicts outcomes in cardiac surgical procedures performed on cardiopulmonary bypass. It’s been widely used in developed nations but it’s applicability in Kenya is unknown. Our objective was to determine its applicability at Kenyatta National Hospital (Kenya). Methods: A retrospective study was carried out between 1st January 2011 and 31st December 2015. Risk factor prevalence was compared with that of the AE derivation population. The AE was calculated; discrimination was determined by receiver operator curve analysis. Results: Of 109 patients, significant differences (Kenyan vs. AE derivation) were found in the prevalence of pulmonary y hypertension (58.7% vs. 2%) and isolated coronary artery bypass graft surgery (4.6% vs. 65%). Only double valve replacement was a risk factor for operative mortality; odds ratio 5.98 (1.83 to 19.49). The area under curve (AUC) for the AE was 0.59. Conclusion: The AUC for the AE implies poor discrimination in our population. Significant differences in the risk factor profile between our study population and the AE score derivation population may have contributed to this. Our findings suggest that the AE may not be applicable to patients in Kenya. We recommend that a local risk scoring system be developed.

Open in new tab Download slide Open in new tab Download slide OBJECTIVES Mitral valve repair is the preferred method used to address mitral valve regurgitation, whereas transcatheter mitral valve repair is recommended for high-risk patients. We evaluated the risk-predictive value of the age-adjusted Charlson comorbidity index (aa-CCI) in the setting of minimally invasive mitral valve surgery. METHODS The perioperative course and 1-year follow-up of 537 patients who underwent isolated or combined minimally invasive mitral valve surgery were evaluated for 1-year mortality as the primary end point and other adverse events. The predictive values of the EuroSCORE II and STS score were compared to that of the aa-CCI by a comparative analysis of receiver operating characteristic curves. Restricted cubic splines were applied to find optimal aa-CCI cut-off values for the increased likelihood of experiencing the predefined adverse end points. Consequently, the perioperative course and postoperative outcome of the aa-CCI ≥8 patients and the remainder of the sample were analysed. RESULTS The predictive value of the aa-CCI does not significantly differ from those of the EuroSCORE II or STS score. Patients with an aa-CCI ≥8 were identified as a subgroup with a significant increase of mortality and other adverse events. CONCLUSIONS The aa-CCI displays a suitable predictive ability for patients undergoing minimally invasive mitral valve surgery. In particular, multimorbid or frail patients may benefit from the extension of the objectively assessed parameters, in addition to the STS score or EuroSCORE II. Patients with an aa-CCI ≥8 have a very high surgical risk and should receive very careful attention. [ABSTRACT FROM AUTHOR]

A total of 100 patients (86% - men, 14% are women), aged 56-69 years, which was later performed coronary artery bypass surgery. The methodology was based on a comprehensive survey assessing the functioning of the heart muscle, the clinical and instrumental parameters, which reflect the state of the cardiovascular system and other vital organs (liver, kidney, pancreas) and blood clotting system. The study developed a mathematical model of the relationship set out indicators ejection fraction of the heart muscle. It is established that as a benchmark, providing a high level of predicting a favorable outcome and the ejection fraction of the myocardium can be considered indicator of the scale of the risk assessment of adverse outcomes (EuroSCORE).

Complexity measures are intended to assess the cardiovascular system's capacity to respond to stressors. We sought to determine if decreased BP complexity is associated with increased estimated risk as obtained from two standard instruments: the Society of Thoracic Surgeons' (STS) Risk of Mortality and Morbidity Index and the European System for Cardiac Operative Risk Evaluation Score (EuroSCORE II). In this observational cohort study, preoperative systolic, diastolic, mean (MAP) and pulse pressure (PP) time series were derived in 147 patients undergoing cardiac surgery. The complexity of the fluctuations of these four variables was quantified using multiscale entropy (MSE) analysis. In addition, the traditional time series measures, mean and standard deviation (SD) were also computed. The relationships between time series measures and the risk indices (after logarithmic transformation) were then assessed using nonparametric (Spearman correlation, rs) and linear regression methods. A one standard deviation change in the complexity of systolic, diastolic and MAP time series was negatively associated (p < 0.05) with the STS and EuroSCORE indices in both unadjusted (21-34%) and models adjusted for age, gender and SD of the BP time series (15-31%). The mean and SD of BP time series were not significantly associated with the risk index except for a positive association with the SD of the diastolic BP. Lower preoperative BP complexity was associated with a higher estimated risk of adverse cardiovascular outcomes and may provide a novel approach to assessing cardiovascular risk. Future studies are needed to determine whether dynamical risk indices can improve current risk prediction tools. [ABSTRACT FROM AUTHOR]

Objective: The Acute Physiology and Chronic Health Evaluation (APACHE) severity of disease classification system, which is one of the most widely used scoring systems to predict mortality, is used for intensive care units (ICU) patients. This study aimed to evaluate the predictive ability of APACHE II for mortality in patients after undergoing cardiac surgery. We studied if APACHE II could successfully predict the outcome in post-cardiac surgery patients. Methods: This study involved retrospective data collection of all adult patients who were admitted to Ordu State Hospital cardiovascular surgery ICU following cardiac surgery from August 2013 to December 2015. Area under the receiver operating characteristic (ROC) curve (AUC) values were calculated for the APACHE II model. Results: During the two years of data collection, we included 600 patients with a mean age of 64.77±10.148 years. Of these, 180 (30.0%) were females. The ICU mortality rate was 8.33%, and the mean length of ICU stay was 4.210±6.913 days. The mean pre-operative EuroSCORE was 3.890±2.565, and the mean pre-operative APACHE II score was 6.790±3.617. The AUC values for APACHE II and EuroSCORE were 0.743 and 0.767, respectively. Conclusion: The APACHE II model can be used to predict mortality in a Turkish population of patients who have undergone cardiac surgery. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to develop a statistical model based on patient parameters to predict the length of stay (LOS) in the intensive care unit (ICU) following cardiac surgery in a single center. Design Data were collected from patients admitted to the ICU following cardiac surgery over a 10-year period (2006-2016). Both the additive and logistic EuroSCORE were calculated, and logistic regression analysis was carried out to formulate a model relating the predicted LOS to the EuroSCORE. This model was used to stratify patients into short stay (less than 48 hours) or long stay (more than 48 hours). Setting ICU at Papworth Hospital, Cambridgeshire. Participants A total of 18,377 consecutive patients who had been in ICU following cardiac surgery (coronary graft bypass surgery, valve surgery, or a combination of both). Interventions This was an observational study. Measurements and Main Results The authors have shown that both the additive and logistic EuroSCORE can be used to stratify cardiac surgical patients in various predicted LOS in ICU. Further adjustments can be made to increase the number of patients correctly identified as either short stay or long stay. Comparison of the model predictions to the data demonstrated a high overall accuracy of 79.77%, and receiver operating characteristic curve analysis showed the area under the curve to be 0.7296. Conclusion This analysis of an extensive data set shows that patient LOS in ICU after cardiac surgery in a single center can be predicted accurately using the simple cardiac operative risk scoring tool EuroSCORE. Using such predictions has the potential to improve ICU resource management. [ABSTRACT FROM AUTHOR]

Objective: The EuroSCORE I was one of the most frequently used pre-operative risk models in cardiac surgery. In 2011 it was replaced by its successor the EuroSCORE II. This study aims to validate the EuroSCORE II and to compare its performance with the EuroSCORE I in a Dutch hospital.Methods: The EuroSCORE II was prospectively validated in 2,296 consecutive cardiac surgery patients between 1 April 2012 and 1 January 2014. Receiver operating characteristic curves on in-hospital mortality were plotted for EuroSCORE I and EuroSCORE II, and the area under the curve was calculated to assess discriminative power. Calibration was assessed by comparing observed versus expected mortality. Additionally, analyses were performed in which we stratified for type of surgery and for elective versus emergency surgery.Results: The observed mortality was 2.4% (55 patients). The discriminative power of the EuroSCORE II surpassed that of the EuroSCORE I (area under the curve EuroSCORE II 0.871, 95% confidence interval (CI) 0.832-0.911; area under the curve additive EuroSCORE I 0.840, CI 0.798-0.882; area under the curve logistic EuroSCORE I 0.761, CI 0.695-0.828). Both the additive and the logistic EuroSCORE I overestimated mortality (predictive mortality additive EuroSCORE I median 5.0%, inter-quartile range 3.0-8.0%; logistic EuroSCORE I 10.7%, inter-quartile range 5.8-13.9), while the EuroSCORE II underestimated mortality (median 1.6%, inter-quartile range 1.0-3.5). In most stratified analyses the EuroSCORE II performed better.Conclusion: Our results show that the EuroSCORE II produces a valid risk prediction and outperforms the EuroSCORE I in elective cardiac surgery patients. [ABSTRACT FROM AUTHOR]

Objective Ongoing debate focuses on whether patients admitted to the hospital on weekends have higher mortality than those admitted on weekdays. Whether this apparent "weekend effect" reflects differing patient risk, care quality differences, or inadequate adjustment for risk during analysis remains unclear. This study aimed to examine the existence of a "weekend effect" for risk-adjusted in-hospital mortality after cardiac surgery. Design Retrospective analysis of prospectively collected cardiac registry data. Setting Ten UK specialist cardiac centers. Participants A total of 110,728 cases, undertaken by 127 consultant surgeons and 190 consultant anesthetists between April 2002 and March 2012. Interventions Major risk-stratified cardiac surgical operations. Measurements and Main Results Crude in-hospital mortality rate was 3.1%. Multilevel multivariable models were employed to estimate the effect of operative day on in-hospital mortality, adjusting for center, surgeon, anesthetist, patient risk, and procedure priority. Weekend elective cases had significantly lower mortality risk compared to Monday elective cases (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.42, 0.96) following risk adjustment by the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) and procedure priority; differences between weekend and Monday for urgent and emergency/salvage cases were not significant (OR 1.12, 95% CI 0.73, 1.72, and 1.07, 95% CI 0.79, 1.45 respectively). Considering only the logistic EuroSCORE but not procedure priority yielded 29% higher odds of death for weekend cases compared to Monday operations (OR 1.29, 95% CI 1.08, 1.54). Conclusions This study suggests that undergoing cardiac surgery during the weekend does not affect negatively patient survival, and highlights the importance of comprehensive risk adjustment to avoid detecting spurious "weekend effects." [ABSTRACT FROM AUTHOR]

Objective: Mortality after cardiac surgery is between 2.94% and 30.7%. In our study, we aimed to compare the significance and the discriminative power of preoperative brain natriuretic peptide (pre BNP), the first 3 days of SOFA, and maximum Sequential Failure Assessment (SOFA) and European System for Cardiac Operative Risk Evaluation (EuroSCORE) in the estimation of long- term mortality in patients who underwent elective isolated coronary artery bypass graft (CABG) operation. Material and Methods: Ethical committee approved our retrospective study. We searched 173 patients who underwent CABG between 2007 and 2009. Patients without blood test results or medical records; those who underwent emergent, additive surgery or different surgical techniques (off-pump); cases that could not be fully mobilized, individuals with left ventricular function below 30%; pulmonary hipertension and those died in operation theatre or within 60 days after surgery were excluded from the study. Thus, 40 out of 173 patients aged between 45, and 80 years were included in the study. BNP blood tests were performed. EuroSCORE scores were calculated from computerized preoperative data Preoperative SOFA scores were measured from patient's data recorded in ICU within postoperative first 24 hours (0-24hr SOFA0), 24-48hr (SOFA1), and 48-72hr (SOFA2), maximum score of 3 days (maxSOFA). SPSS 15.0 was used. Obtained results were evaluated within 95% confidence interval and the level of significance was accepted as p<0.05. Results: SOFA1 scores in exited cases are more significant than EuroSCORE scores when compared with those survived. (SOFA1 p<0.05, EuroSCORE p=0.06). There is a positive correlation between preBNP and SOFA1 (p<0.05), SOFA2 (p<0.01) and EuroSCORE (p<0.01) scores. According to area under curve in ROC analysis (AUC) SOFA1 was evaluated as "very good"(AUC: 0.764, p=0.02), and EuroSCORE as "good" (AUC: 0.727, p=0.05) in the prediction of mortality. Conclusion: To the best of our knowledge,SOFA score has not been compared with preBNP in the evaluation of mortality. Higher SOFA scores, and preBNP values are correlated with mortality in patients with CABG. In our study, we found that SOFA1 is more significant than the other mortality prediction methods in the long term mortality of the patients following CABG. [ABSTRACT FROM AUTHOR]

A risk prediction model is a mathematical equation that uses patient risk factor data to estimate the probability of a patient experiencing a healthcare outcome. Risk prediction models are widely studied in the cardiothoracic surgical literature with most developed using logistic regression. For a risk prediction model to be useful, it must have adequate discrimination, calibration, face validity and clinical usefulness. A basic understanding of the advantages and potential limitations of risk prediction models is vital before applying them in clinical practice. This article provides a brief overview for the clinician on the various issues to be considered when developing or validating a risk prediction model. An example of how to develop a simple model is also included. [ABSTRACT FROM AUTHOR]