The Value of EuroSCORE II for Mortality Prediction in Isolated Tricuspid Valve Surgery

Objectives: Isolated tricuspid valve (TV) surgery is considered a high risk-procedure with high mortality. It is common practice to assess mortality risk in cardiac surgery using specific risk scores. In the lack of a specific risk score for isolated TV surgery, EuroSCORE II is often used for this purpose. It was the aim of this study to assess the value of risk assessment by EuroSCORE II in patients undergoing isolated TV surgery.

Methods: Between April 2011 and May 2019, a total of 140 patients underwent isolated tricuspid valve repair (n = 98, 70%) or replacement (n = 42, 30%) due to TV regurgitation in our center. We retrospectively assessed preoperative characteristics, intraoperative findings, complications and mortality for short and mid-term survival (mean follow-up 2.5 years, range: 1 day to 8.4 years). EuroSCORE II was calculated for all patients and related to clinical outcome. To characterize the predictive value of EuroSCORE II, patients were stratified into two groups: above and below median value (6.52%).

Result: Patients were 71 ± 11 years of age, 42% were males (n = 59) and mean LVEF was 55.5 ± 12.2%. Patients suffered from relevant comorbidities: endocarditis 16% (n = 23), pulmonary hypertension 54% (n = 76), COPD 21% (n = 30), atrial fibrillation 30% (n = 85%), dialysis 9% (n = 12) and 40% (n = 56) had at least one previous operation. Median EuroSCORE II was 6.52% (range: 0.5–62%). Mortality at 30 days was 7.9% (n = 11), suggesting a slight underestimation of risk. Preoperative LVEF, dialysis, cardiogenic shock and in particular liver function were predictors of 30-day mortality. Despite tremendous differences of the two EuroSCORE II groups (median 3.70% [range: 5–6.51%] vs. 12.6% [range: 6.52–62%]) there were no difference in perioperative and mid-term survival observed. Multivariable analysis failed to identify EuroSCORE II as independent predictor of mortality in this patient population.

Conclusion: Preoperative risk assessment by classic risk scores such as EuroSCORE II does not appear to reflect the specific risks predictive of mortality in patients undergoing isolated tricuspid valve surgery. Alternative strategies for risk assessment considering comorbidities such as liver dysfunction are needed in these patients.

Publikationsverlauf

Artikel online veröffentlicht:
19. Februar 2021