Predicting 30-day mortality of aortic valve replacement by the AVR score

Abstract

Objectives The objective of this study is to develop a simple risk score to predict 30-day mortality of aortic valve replacement (AVR). Methods In a development set of 673 consecutive patients who underwent AVR between 1990 and 1993, four independent predictors for 30-day mortality were identified: body mass index (BMI) ≥30, BMI <20, previous coronary artery bypass grafting (CABG) and recent myocardial infarction. Based on these predictors, a 30-day mortality risk score-the AVR score-was developed. The AVR score was validated on a validation set of 673 consecutive patients who underwent AVR almost two decennia later in the same hospital. Results Thirty-day mortality in the development set was ≤2% in the absence of any predictor (class I, low risk), 2-5% in the solitary presence of BMI ≥30 (class II, mild risk), 5-15% in the solitary presence of previous CABG or recent myocardial infarction (class III, moderate risk), and >15% in the solitary presence of BMI <20, or any combination of BMI ≥30, previous CABG or recent myocardial infarction (class IV, high risk). The AVR score correctly predicted 30-day mortality in the validation set: observed 30-day mortality in the validation set was 2.3% in 487 class I patients, 4.4% in 137 class II patients, 13.3% in 30 class III patients and 15.8% in 19 class IV patients. Conclusions The AVR score is a simple risk score validated to predict 30-day mortality of AVR.

What Can We Learn from the Past by Means of Very Long-Term Follow-Up after Aortic Valve Replacement?

“…To illustrate this, the mean age of the patients of the current study population at the time of surgery between 1990 and 1994 was 65.4 ± 10.7 years. This is in contrast to the mean age of 70.6 ± 10.6 years of the patients in a previous study who had served as a validation set for the development of the "AVR score" and had also undergone AVR with or without concomitant CABG for symptomatic or asymptomatic severe AS and/or AR in the same hospital as the patients of the current study, however two decennia later (between 2007 and 2009) [26]. Partly due to the higher age itself, operative risk scores in the patients operated upon between 2007 and 2009 were higher in comparison to the patients of the current study who had been operated upon between 1990 and 1994 (logistic EuroSCORE: 8.1 ± 7.3 vs. 5.0 ± 5.1, respectively), as were the 30-day mortality rates (3.6% vs. 2.8%, respectively).…”

Conventional aortic valve replacement or transcatheter aortic valve implantation in patients with previous cardiac surgery

“…In conventional surgical AVR, it is well-known that previous cardiac surgery represents an independent risk factor, which is associated with increased morbidity and mortality compared with first-time surgery. One surgical series reported a 11-fold increase for 30-day mortality in patients with previous CABG undergoing redo-AVR [7]. In a previous evaluation, we published an OR of 3.3 (95% CI 1.1-10.2) for repeat cardiac surgery in our institution [8].…”

Predictors of Early Mortality After Aortic Valve Replacement in Middle-Aged Rheumatic Patients

“…Risk factors of mortality after AVR vary widely between different centers. Previously reported risk factors included old age, congestive heart failure, myocardial infarction, low EF, left ventricular dysfunction, emergency operation, type and size of the prosthesis, concomitant procedure especially coronary artery bypass grafting (CABG) and mitral valve replacement (MVR), long cross-clamp time, long cardiopulmonary bypass time, need of intra-aortic balloon pump, low cardiac output syndrome , and postoperative complications [1,7] Swinkels and associates developed the AVR score as a simple risk score to predict 30-day mortality [8]. Euroscore and STS score, though more complex, they can provide a first quick-look impression of 30-day mortality after AVR.…”