Modified scale for prognosis of surgical risk in aortic arch surgery

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Aim — to present optimal scale for predicting preoperative risk in aortic arch surgery. Material and methods. Retrospective analysis included 88 patients who had undergone aortic arch replacement for the period from January 2014 to July 2017. Thirteenth patients were excluded from the analysis because of some variables which are necessary for both scales were unknown in those patients. Results. «E-vita open plus» hybrid stent-graft (Jotec, Germany) was implanted in 23 (30.7%) patients. There were 8 (10.7%) redo procedures on the thoracic aorta. According to the modified scale, all patients with severity index (SI) less than 0.5 (n=58) survived, 3 out of 17 patients with SI over 0.5 died. Relative risk of in-hospital life-threatening complications in patients with SI over 0.5 compared with those with SI less than 0.5 was 3.55. Area under ROC-curve for modified scale (98.6%) was significantly greater than for EuroScore II scale (71.1%) (p<0.003). Conclusion. Risk assessment scale in aortic arch surgery should take into account all surgical features and be easy for application. In our trial, areas under ROC-curves for EuroSCORE II and modified scales were 71.1 and 98.6%, respectively (p=0.003). Scales are recommended to be used for planning of surgery, informing patients and auditing the results of treatment between various medical institutions and individual specialists.

Keywords:

aortic arch surgery

aortic arch aneurysm

aortic arch dissection

EuroScore II

Authors:

Charchian É.R.

RNTsKh im. akad. B.V. Petrovskogo RAMN

SPIN RSCI: 4641-0523
Scopus AuthorID: 14044681400
ORCID: 0000-0002-0488-2560

Gerasimov A.N.

Sechenov First Moscow State Medical University, Moscow, Russia

Skvortsov A.A.

Federal State Budget Organization National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow, Russia

Khachatryan Z.R.

Department of Aortic Surgery (head — MD E.R. Charchyan), Acad. B.V. Petrovsky Russian Research Center for Surgery (director — acad. of RAS Yu.V. Belov), Moscow, Russia

Mamedova N.M.

B.V. Petrovsky Russian Scientific Center of Surgery, Moscow, Russia

Isaev R.M.

Chair of Cardiovascular Surgery and Interventional Cardiology (head — acad.of RAS Yu.V. Belov), acad. B.V. Petrovskiy Russian Research Centre of Surgery, Chair of Medical Informatics and Statistics (head — prof. A.N. Gerasimov) of I.M. Sechenov First Moscow State Medical University

Belov Yu.V.

RNTsKh im. akad. B.V. Petrovskogo RAMN

SPIN RSCI: 2740-1439
Scopus AuthorID: 7101862336
ResearcherID: 7101862336
ORCID: 0000-0002-9280-8845

List of references:

Belov YuV, Isaev RM. Risk stratification in cardiovascular surgery. Surgery. 2014;7:78-81. (In Russ.)
Kozlov BN, Panfilov DS, Zavadovsky KV, Saushkin VV, Kuznetsov MS, Nasrashvili GG, Andriyanova AV, Shipulin VM. Hybrid surgery of the aortic arch. Siberian Medical Journal. 2015;30:2:60-64. (In Russ.)
Di Bartolomeo R, Berretta P, Pantaleo A, Murana G, Cefarelli M, J. Alfonsi Giuseppe Barberio, Alessandro Leone, Luca Di Marco, Davide Pacini. Long-Term Outcomes of Open Arch Repair After a Prior Aortic Operation: Our Experience in 154 Patients. Ann Thorac Surg. 2017;103:1406-1412. https://doi.org/10.1016/j.athoracsur.2016.08.090
Gambardella I, Gaudino M, Lau C, Munjal M, Di Franco A, Ohmes LB, Hameedi F, Spadaccio C, Girardi LN. Contemporary results of hemiarch replacement. Eur J Cardiothorac Surg. 2017;1:52:333-338. https://doi.org/10.1093/ejcts/ezx071
Charchyan ER, Abugov SA, Stepanenko AB, Puretsky MV, Polyakov RS, Khachatryan ZR. Hybrid operations in the pathology of the thoracic aorta. Clinical and Experimental Surgery. 2014;4:31-36. (In Russ.)
Qian Zhang, Xiaochun Ma, Wenlong Zhang, Zhengjun Wang, Haizhou Zhang, Xiaofeng Zhang, Jian Song, Chengwei Zou Surgical repair and reconstruction of aortic arch in debakey type I aortic dissection: recent advances and single-center experience in the application of branched stent graft. Journal of Cardiothoracic Surgery. 2017;12:2-9. https://doi.org/10.1186/s13019-017-0649-6
Shresthaa M, Bachetb J, Bavariac J, Carreld TP, Ruggero De Paulise, Roberto Di Bartolomeof, Christian D. Etzg, Grabenwögerh M, Grimmi M, Havericha A, Jakobj H, Martensa A, Mestresk CA, Pacinif D, Reschm T, Schepensn M, Urbanskio PP, Czerny M. Current status and recommendations for use of the frozen elephant trunk technique: a position paper by the Vascular Domain of EACTS. European Journal of Cardio-Thoracic Surgery. 2015;47:759-769. Epub 2015 Mar 13. https://doi.org/10.1093/ejcts/ezv085
Perez MA, Llaneza Coto JM, Jose Antonio del castro Madrazo, Carlota Fernandes Prendes, Mario Gonzales Gay, Amer Zanabili Al Sibbai. Debranching aortic surgery. Journal of Thoracic Disease 2017;9:465-477. https://doi.org/10.21037/jtd.2017.03.87
Bosiers MJ, Donas KP, Mangialardi N, et al. European multicenter registry for the performance of the Chimney/Snorkel Technique in the treatment of aortic arch pathologic conditions. Ann Thorac Surg. 2016;101:2224-2230. Epub 2016 Jan 12. https://doi.org/10.1016/j.athoracsur.2015.10.112
Yuri K, Kimura N, Hori D, Yamaguchi A, Adachi H. A Challenging Treatment for Aortic Arch Aneurysm With Fenestrated Stent Graft. Ann Thorac Surg. 2017;104:1915-1922. Epub2017Aug 25 https://doi.org/10.1016/j.athoracsur.2017.05.062
Preventza O, Garcia A, Cooley DA, et al. Reoperations on the total aortic arch in 119 patients: short- and mid-term outcomes, focusing on composite adverse outcomes and survival analysis. J Thorac Cardiovasc Surg. 2014;148:2967-2972. https://doi.org/10.1016/j.jtcvs.2014.12.035
Ioannis K. Noumpoulis, Constantine E. Anagnostopoulos, Daniel G. Swistel, Joseph J. DeRose Jr. Does EuroSCORE predict length of stay and specific postoperative complications after cardiac surgery? European Journal of Cardio-Thoracic Surgery. 2005;27:128-133. https://doi.org/10.1016/j.ejcts.2004.09.020
Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E, Cortina J, David M, Faichney A, Gabrielle F, Gams E, Harjula A, Jones MT, Pintor PP, Salamon R, Thulin L. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19,030 patients. Eur J Cardiothorac Surg. 1999;15:816-823.
Pitkanen O, Niskanen M, Rehnberg S, Hippelainen M, Hynynen M. Intra institutional prediction of outcome after cardiac surgery: comparison between a locally derived model and the EuroSCORE. European Journal of Cardio-Thoracic Surgery. 2000;18:703-710.
Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, Lockowandt U. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41:734-744. Epub 2012 Feb 29. https://doi.org/10.1093/ejcts/ezs043
Belov YuV, Gerasimov AN, Charchyan ER, Komarov RN, Vikentyev VV, Alekseev IA, Ivanov NV, Isaev RM. EuroSCORE model ARCH: Prognosis of perioperative risk factors in aortic arch surgery with cerebral protection. Cardiology and cardiovascular surgery. 2015;8(4):17-25. (In Russ.) https://doi.org/10.17116/kardio20158417-25
Denton A. Cooley. A Brief History of Aortic Aneurysm Surgery Aorta. 2013;1:1-3. https://doi.org/10.12945/j.aorta.2013.12.006
Dodge-Khatami A. Ascending aortic slide for interrupted aortic arch repair. Transl pediatr. 2018;7:71-72. https://doi.org/10.21037/tp.2017.09.02
Li Y, Hu Z, Wang J, Zhang Y, Chen Z, Zhang H. Endovascular Chimney Technique for Aortic Arch Pathologies Treatment: A Systematic Review and Metaanalysis. Ann Vasc Surg. 2018;47:305-315. Epub 2017 Sep 22 https://doi.org/10.1016/j.avsg.2017.09.006
Tacher V, Scheller K, Desgranges P, Kobeiter H. Endovascular aortic arch repair using customs made branched stent graft under three-dimensional image fusion guidance. Diagnostic and Interventional Imaging. 2018. https://doi.org/10.1016/j.diii.2018.01.007
Colli A, Carrozzini M, Francescato A, Galuppo M, Comisso M, Toto F, Gregori D, Gerosa G. Acute DeBakey Type I aortic dissection without intimal tear in the arch: is total arch replacement the right choice? Interact Cardiovasc Thorac Surg. 2018;26:84-90. https://doi.org/10.1093/icvts/ivx229
Qorbani M, Safiri S. Severe aortic arch calcification predicts mortality in patients undergoing peritoneal dialysis: Methodological issues. J Formos Med Assoc. 2018;117:85-86. Epub 2017 Oct 5 https://doi.org/10.1016/j.jfma.2017.09.011.
Carlo Prins, I De Villiers Jonker, Lezelle Botes, Francis E Smit, Cardiac surgery risk-stratification. Cardiovascular journal of Africa. 2012;23:160-164. https://doi.org/10.5830/CVJA-2011-047
Zweig MH, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clinical Chemistry. 1993;39:561-557.
Swets JA. Measuring the accuracy of diagnostic systems. Science. 1988;240:1285-1293.
LeGall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;24:2957-2963.
Le Gall JR, Loirat P, Alpérovitch A. APACHE II — a severity of disease classification system. Crit Care Med. 1986;14:754-755.
Leteurtre S, Martinot A, Duhamel A, Proulx F, Grandbastien B, Cotting J, Gottesman R, Joffe A, Pfenninger J, Hubert P, Lacroix J, Leclerc F. Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet. 2003;19:192-197. https://doi.org/10.1016/S0140-6736(03)13908-6
Parsonnet V, et al. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation. 1989;79:3-12.
Bernstein AD, Parsonnet V. Bedside estimation of risk as an aid for decision-making in cardiac surgery. Ann Thorac Surg. 2000;69:823-828.
Anderson RP. First publications from the Society of Thoracic Surgeons National Database. Ann Thorac Surg. 1994;57:6-7.
Shahian DM, O’Brien SM, Filardo G, Ferraris VA, Haan CK, Rich JB, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: Part 1 — coronary artery bypass grafting surgery. Ann Thorac Surg. 2009;89(1):Suppl 1:S2-S22. https://doi.org/10.1016/j.athoracsur.2009.05.053
Nashef SA, Raques F, Michel P, et al. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999;16:9-13.
Huijskes RV, Wesselink RM, Noyez L, Rosseel PM, Klok T, van Straten BH, Nesselaar A, Tijssen JG. Predictive models for thoracic aorta surgery. Is the Euroscore the optimal risk model in the Netherlands? Interactive cardiovascular and thoracic surgery. 2005;22:538-542. https://doi.org/10.1510/icvts.2005.108761
Matsuura K, Ogino H, Matsuda H, Minatoya K, Sasaki H, Yagihara T, Kitamura S. Limitations of EuroSCORE for measurement of risk-stratified mortality in aortic arch surgery using selective cerebral perfusion: is advanced age no longer a risk? Ann Thorac Surg. 2006;81:2084-2087. https://doi.org/10.1016/j.athoracsur.2006.01.018
Yoshito Kawachi, Atsuhiro Nakashima, Yoshihiro Toshima, Kouich Arinaga, Hiroshi Kawano. Risk stratification analysis of operative mortality in heart and thoracic aorta surgery: comparison between Parsonnet and EuroSCORE additive model. European Journal of Cardio-Thoracic Surgery. 2001;20:961-966.
Ad N, Holmes SD, Patel J, Pritchard G, Shuman DJ, Halpin L. Comparison of EuroSCORE II, original EuroSCORE, and The Society of Thoracic Surgeons risk score in cardiac surgery patients. Ann Thorac Surg. 2016;102:573-579. Epub 2016 Apr 23. https://doi.org/10.1016/j.athoracsur.2016.01.105
Dusko Nezic. Comparison of Different Risk Models for Prediction of Patient Outcomes in Cardiac Operations. Ann Thorac Surg. 2017;103:1036-1041. https://doi.org/10.1016/j.athoracsur.2016.08.009
Nishida T, Masuda M, Tomita Y, Tokunaga S, Tanoue Y, Shiose A, Morita S, Tominaga R. The logistic EuroSCORE predicts the hospital mortality of the thoracic aortic surgery in consecutive 327 Japanese patients better than the additive EuroSCORE. Eur J Cardiothorac Surg. 2006;30:578-582. Epub 2006 Aug 28. https://doi.org/10.1016/j.ejcts.2006.07.011
Barmettler H, Immer FF, Berdat AP, Eckstein FS, Kipfer B, Carrel TP. Risk stratification in thoracic aortic surgery: should the EuroSCORE be modified? Eur J Cardiothorac Surg. 2004;25:691-695. https://doi.org/10.1016/j.ejcts.2004.01.003
Nishida T, Sonoda H, Oishi Y, Tanoue Y, Nakashima A, Shiokawa Y, Tominaga R. The novel EuroSCORE II algorithm predicts the hospital mortality of thoracic aortic surgery in 461 consecutive Japanese patients better than both the original additive and logistic EuroSCORE algorithms. Interact Cardiovasc Thorac Surg. 2014;18:446-450.Epub 2013 Dec 23 https://doi.org/10.1093/icvts/ivt524
Yipeng Ge, Lizhong Sun, Junming Zhu, Yongmin Liu, Lijian Cheng, Lei Chen, Jun Zheng, Chengnan Li, Wei Liu Can EuroSCORE II Predict the Mortality and Length of Intensive Care Unit Stay after Total Aortic Arch Replacement with Stented Elephant Trunk Implantation for DeBakey Type I Aortic Dissection? Thoracic and Cardiovascular Surgeon. 2013;61:564-568. https://doi.org/10.1055/s-0033-1348197
Wang Ch, Yao F, Han L, et al. Validation of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) in Chinese Heart Valve Surgery Patients. The Journal of Heart Valve Disease. 2010;l9:21-27.
Kovacs J, Moraru L, Antal K, Cioc A, Voidazan S, Szabo A. Are frailty scales better than anesthesia or surgical scales to determine risk in cardiac surgery? Korean J Anesthesiol. 2017;70:157-162. Epub2016Dec 1. https://doi.org/10.4097/kjae.2017.70.2.157
Li CN, Chen L, Ge YP, Zhu JM, Liu YM, Zheng J, Liu W, Ma WG, Sun LZ. Risk factors for prolonged mechanical ventilation after total aortic arch replacement for acute DeBakey type I aortic dissection. Heart Lung Circ. 2014;23:869-874. https://doi.org/10.1016/j.hlc.2014.03.022

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