Risk Assessment

  • Ettore AugugliaroEmail author


Every year millions of patients who suffer from valvular heart disease (VHD) undergo a heart surgery. The comorbidity, prior clinical conditions, but also surgery, anesthesia, an intensive post-operative care, so all the perioperative and post-operative procedures have an important prognostic effect on patient morbidity and mortality.


  1. 1.
    Garfein AJ, Herzog AR. Robust aging among the young-old, old-old, and oldest-old. J Gerontol B Psychol Sci Soc Sci. 1995;50((2):S77–87.CrossRefGoogle Scholar
  2. 2.
    The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012;33:2451–96.CrossRefGoogle Scholar
  3. 3.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC Guideline for the management of patients with valvular heart disease a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):2440–92.CrossRefGoogle Scholar
  4. 4.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JPIII, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O’Gara PT, Rigolin VH, Sundt TMIII, Thompson A. AHA/ACC Focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017.;
  5. 5.
    Baumgartner H, Hung J, Bermejo J, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Eur J Echocardiogr. 2009;10:1–25.CrossRefGoogle Scholar
  6. 6.
    Lancellotti P, Tribouilloy C, Hagendorff A, Moura L, Popescu BA, Agricola E, Monin JL, Pierard LA, Badano L, Zamorano JL, European Association of Echocardiography. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1. Aortic and pulmonary regurgitation (native valve disease). Eur J Echocardiogr. 2010;11:223–44.CrossRefGoogle Scholar
  7. 7.
    Rosenhek R, Iung B, Tornos P, et al. ESC Working group on valvular heart disease position paper: assessing the risk of interventions in patients with valvular heart disease. Eur Heart J. 2012;33:822–8.CrossRefGoogle Scholar
  8. 8.
    Debonnaire P, et al. Value of the “TAVI2-SCORe” versus surgical risk scores for prediction of one year mortality in 511 patients who underwent transcatheter aortic valve implantation. Am J Cardiol. 2015;115(2):234–42.CrossRefGoogle Scholar
  9. 9.
    Geissler HJ, Holzl P, Marohl S, Kuhn-Regnier F, Mehlhorn U, Südkamp M, Rainer de Vivie E. Risk stratification in heart surgery: comparison of six score systems. Eur J Cardiothorac Surg. 2000;17(4):400–6.CrossRefGoogle Scholar
  10. 10.
    Prins C, Jonker DV, Botes L, Smit FE. Cardiac surgery risk-stratification models. Cardiovasc J Afr. 2012;23(3):160–4.CrossRefGoogle Scholar
  11. 11.
    Nashef SAM, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41:734–45.CrossRefGoogle Scholar
  12. 12.
    Noyez L, Kievit PC, van Swieten HA, de Boer M-J. Cardiac operative risk evaluation: the EuroSCORE II, does it make a real difference? Neth Heart J. 2012;20:494–8.CrossRefGoogle Scholar
  13. 13.
    Roques F, Michel P, Goldstone AR, Nashef SA. The logistic EuroSCORE. Eur Heart J. 2003;24(9):882–3.CrossRefGoogle Scholar
  14. 14.
    Clark RE. The STS national database: alive, well, and growing. Ann Thorac Surg. 1991;52(1):5.CrossRefGoogle Scholar
  15. 15.
    Clark RE. The Society of Thoracic Surgeons National Database status report. Ann Thorac Surg. 1994;57(1):20–6.CrossRefGoogle Scholar
  16. 16.
    Welke KF, Ferguson TB, Coombs LP, Dokholyan RS, Murray CJ, Schrader MA, Peterson ED. Validity of the society of thoracic surgeons National Adult Cardiac Surgery Database. Ann Thorac Surg. 2004;77(4):1137–9.CrossRefGoogle Scholar
  17. 17.
    Brown JM, Wu C, Sikora JH, Griffith BP, Gammie JS. Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database. J Thorac Cardiovasc Surg. 2009;137:82–90.CrossRefGoogle Scholar
  18. 18.
    Ranucci M, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G. Risk of assessing mortality risk in elective cardiac operations age, creatinine, ejection fraction, and the law of parsimony. Circulation. 2009;119:3053–61.CrossRefGoogle Scholar
  19. 19.
    Ranucci M, Castelvecchio S, Conte M, Megliola G, Speziale G, Fiore F, Guarracino F, Scolletta S, Escobar RM, Falco M, Bignami E, Landoni G. The easier, the better: age, creatinine, ejection fraction score for operative mortality risk stratification in a series of 29,659 patients undergoing elective cardiac surgery. J Thorac Cardiovasc Surg. 2011;142(3):581–6. Epub 2011 Jun 24.CrossRefGoogle Scholar
  20. 20.
    Ranucci M, Pistuddi V, Scolletta S, de Vincentiis C, Menicanti L. The ACEF II Risk Score for cardiac surgery: updated but still parsimonious. Eur Heart J. 2017.; CrossRefGoogle Scholar
  21. 21.
    Shahian DM, et al. The society of thoracic surgeons risk model for operative mortality after multiple valve surgery (Part 1-2-3). Eur J Cardiothorac Surg. 2013;95(4):1484–90.Google Scholar
  22. 22.
    Barili F, et al. Does Euroscore II perform better than its original version? A multicentre validation study. Eur Heart J. 2013;34(1):22–9.CrossRefGoogle Scholar
  23. 23.
    Durand E, et al. Performance analysis of Euroscore II compared to the original logistic EuroSCORE and STS scores for predicting 30-day mortality after TAVI. Am J Cardiol. 2013;111(6):891–7.CrossRefGoogle Scholar
  24. 24.
    Stähli B, et al. Early and late mortality in patients undergoing transcatheter aortic valve implantation: comparison of the novel EuroScore II with established risk scores. Cardiology. 2013;126(1):15–23.CrossRefGoogle Scholar
  25. 25.
    Haensig M, et al. Is the new EuroSCORE II a better predictor for transapical aortic valve implantation? Eur J Cardiothorac Surg. 2013;44(2):302–8.CrossRefGoogle Scholar
  26. 26.
    Osnabrugge RL, et al. Performance of EuroSCORE II in a large US database: implications for transcatheter aortic valve implantation. Eur J Cardiothorac Surg. 2014;46(3):400–8.CrossRefGoogle Scholar
  27. 27.
    Biancari F, et al. Meta-analysis on the performance of the EuroSCORE II and the Society of Thoracic Surgeons Scores in patients undergoing aortic valve replacement. J Cardiothorac Vasc Anesth. 2014;28(6):1533–9.CrossRefGoogle Scholar
  28. 28.
    Guida P, Mastro F, Scrascia G, Whitlock R, Paparella D. Performance of the European system for cardiac operative risk evaluation II: a meta-analysis of 22 studies involving 145,592 cardiac surgery procedures. J Thorac Cardiovasc Surg. 2014;148(6):3049–57.e1.CrossRefGoogle Scholar
  29. 29.
    Zbroński K, Huczek Z, Puchta D, Paczwa K, Kochman J, Wilimski R, Scisło P, Rymuza B, Filipiak KJ, Opolski G. Outcome prediction following transcatheter aortic valve implantation: multiple risk scores comparison. Cardiol J. 2016;23(2):169–77.CrossRefGoogle Scholar
  30. 30.
    D’Ascenzo F, Ballocca F, Moretti C, Barbanti M, Gasparetto V, Mennuni M, D’Amico M, Conrotto F, Salizzoni S, Omedè P, Colaci C, Zoccai GB, Lupo M, Tarantini G, Napodanno M, Presbitero P, Sheiban I, Tamburino C, Marra S, Gaita F. Inaccuracy of available surgical risk scores to predict outcomes after transcatheter aortic valve replacement. J Cardiovasc Med (Hagerstown). 2013;14(12):894–8.CrossRefGoogle Scholar
  31. 31.
    Sullivan PG, Wallach JD, Ioannidis JPA. Meta-analysis comparing established risk prediction models (EuroSCORE II, STS Score, And ACEF Score) for perioperative mortality during cardiac surgery. Am J Cardiol. 2016;118(10):1574–82.CrossRefGoogle Scholar
  32. 32.
    Ranucci M. The hidden traps of meta-analyses on cardiac surgery mortality risk scores. Am J Cardiol. 2017;120:337–8.CrossRefGoogle Scholar
  33. 33.
    Tanemoto HFK. Frailty in cardiothoracic surgery: systematic review of the literature. Gen Thorac Cardiovasc Surg. 2015;63:425–33.CrossRefGoogle Scholar
  34. 34.
    Silvay G, Zafirova Z. Ten years experiences with preoperative evaluation clinic for day admission cardiac and major vascular surgical patients: model for “perioperative anesthesia and surgical home”. Semin Cardiothorac Vasc Anesth. 2016;20(2):120–32.CrossRefGoogle Scholar
  35. 35.
    Daabiss M. American society of Anesthesiologists physical status classification. Indian J Anaesth. 2011;55:111–5.CrossRefGoogle Scholar
  36. 36.
    Dupuis J-Y, Wang F, Nathan H, Lam M, Grimes S, Bourke M. The cardiac anesthesia riskevaluation score a clinically useful predictor of mortality and morbidity after cardiac surgery. Anesthesiology. 2001;94:194–204.CrossRefGoogle Scholar
  37. 37.
    Visser A, Geboers B, Gouma DJ, Goslings JC, Ubbinik DT. Predictors of surgical complications: a systematic review. Surgery. 2015;158:58–65.CrossRefGoogle Scholar
  38. 38.
    Cohen ME, Liu Y, Ko CY, Hall BL. An examination of American College of Surgeons NSQIP surgical risk calculator accuracy. J Am Coll Surg. 2017;224(5):787–795.e1.CrossRefGoogle Scholar
  39. 39.
    Bilimoria KY, Liu Y, Paruch JL, Kmiecik TE, Ko CY, Cohen ME. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013;217(5):833–842.e3.CrossRefGoogle Scholar
  40. 40.
    Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–51.CrossRefGoogle Scholar
  41. 41.
    Tamayo E, Fierro I, Bustamante-Munguira J, Heredia-Rodríguez M, Jorge-Monjas P, Maroto L, Gómez-Sánchez E, Bermejo-Martín FJ, Álvarez FJ, Gómez-Herreras J. Development of the post cardiac surgery (POCAS) prognostic score. Crit Care. 2013;17:R209.CrossRefGoogle Scholar
  42. 42.
    Ranucci M, Ballotta A, Castelvecchio S, Baryshnikova E, Brozzi S, Boncilli A, for the Surgical and Clinical Outcome Research (SCORE) Group. Intensive care unit admission parameters improve the accuracy of operative mortality predictive models in cardiac surgery. PLoS One. 2010;5(10):e13551.CrossRefGoogle Scholar
  43. 43.
    Kotera A, Haga Y, Kei J, Okamoto M, Seo K. Evaluation of estimation of physiologic ability and surgical stress to predict in-hospital mortality in cardiac surgery. J Anesth. 2011;25(4):481–91.CrossRefGoogle Scholar
  44. 44.
    Magruder JT. A predictive model and risk score for unplanned cardiac surgery intensive care unit readmissions. J Card Surg. 2015;30(9):685–90.CrossRefGoogle Scholar
  45. 45.
    Bagnall NM, Faiz O, Darzi A, Athanasiou T. What is the utility of preoperative frailty assessment for risk stratification in cardiac surgery? Interact Cardiovasc Thorac Surg. 2013;17(2):398–402.CrossRefGoogle Scholar
  46. 46.
    Rowe R, Iqbal J, Murali-krishnan R, Sultan A, Orme R, Briffa N, Denvir M, Gunn J. Role of frailty assessment in patients undergoing cardiac interventions. BMJ. 2017;1:e000033.Google Scholar
  47. 47.
    Mack M. Frailty and aortic valve disease. J Thorac Cardiovasc Surg. 2013;145(3 Suppl):S7–10.CrossRefGoogle Scholar
  48. 48.
    Afilalo J, Mottillo S, Eisenberg MJ, Alexander KP, Noiseux N, Perrault LP, Morin J-F, Langlois Y, Ohayon SM, Monette J, Boivin J-F, Shahian DM, Bergman H. Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes. 2012;5:222–8.CrossRefGoogle Scholar
  49. 49.
    Chen X, Mao G, Leng SX. Frailty syndrome: an overview. Clin Interv Aging. 2014;9:433–41.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Sepehri A, Beggs T, Hassan A, Rigatto C, Shaw-Daigle C, Tangri N, Arora RC. The impact of frailty on outcomes after cardiac surgery: a systematic review. J Thorac Cardiovasc Surg. 2014;148(6):3110–7.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Maria Eleonora Hospital, Palermo-GVM-Care and ResearchPalermoItaly

Personalised recommendations