Machine learning-based risk profile classification of patients undergoing elective heart valve surgery

OBJECTIVES Machine learning methods potentially provide a highly accurate and detailed assessment of expected individual patient risk before elective cardiac surgery. Correct anticipation of this risk allows for the improved counselling of patients and avoidance of possible complications. We therefore investigated the benefit of modern machine learning methods in personalized risk prediction for patients undergoing elective heart valve surgery. METHODS We performed a monocentric retrospective study in patients who underwent elective heart valve surgery between 1 January 2008 and 31 December 2014 at our centre. We used random forests, artificial neural networks and support vector machines to predict the 30-day mortality from a subset of 129 available demographic and preoperative parameters. Exclusion criteria were reoperation of the same patient, patients who needed anterograde cerebral perfusion due to aortic arch surgery and patients with grown-up congenital heart disease. Finally, the cohort consisted of 2229 patients with a 30-day mortality of 3.86% (86 of 2229 cases). This trial has been registered at clinicaltrials.gov (NCT03724123). RESULTS The final random forest model trained on the entire data set provided an out-of-bag area under the receiver operator characteristics curve (AUC) of 0.839, which significantly outperformed the European System for Cardiac Operative Risk Evaluation (EuroSCORE) (AUC = 0.704) and a model trained only on the subset of features EuroSCORE uses (AUC = 0.745). CONCLUSIONS Advanced machine learning methods can predict outcomes of valve surgery procedures with higher accuracy than established risk scores based on logistic regression on pre-selected parameters. This approach is generalizable to other elective high-risk interventions and allows for training models to the cohorts of specific institutions