Background:
Risk models play important roles in stratification and decision-making towards cardiac surgery. Isolated tricuspid valve surgery (TVR) is a high risk but increasingly performed operation, however the performance of surgical risk models, including the recently developed Society of Thoracic Surgeon’s (STS) TVR score, have not been externally evaluated in these patients. We compared the prognostic utility of contemporary risk scores for isolated TVR.
Methods:
Consecutive patients undergoing isolated TVR at Cleveland Clinic during 2004-2018 were evaluated. EuroSCORE II and STS-TVR score were retrospectively calculated, and their performance for predicting 30-day mortality, post-operative complications and mortality during follow-up were assessed.
Results:
Amongst 207 patients studied, mean age was 54.1±17.9 years, 116 (56.0%) were female, 92 (44.4%) had secondary tricuspid regurgitation, and 151 (72.9%) had surgical repair. Mean EuroSCORE II and STS-TVR scores were 6.3±6.6% and 5.5±6.2% respectively. Operative mortality occurred in 10 (4.9%). C-statistics (95% confidence intervals) for 30-day mortality were 0.83 (0.74-0.93) for EuroSCORE II and 0.60 (0.45-0.75) for STS-TVR score (Table), and observed/expected ratios were 0.78 and 0.89 respectively. EuroSCORE II also had higher c-statistics for composite and most post-operative complications. In univariable Cox regression for mortality during follow-up, hazards ratios (95% confidence intervals) were 1.08 (1.05-1.11) for EuroSCORE II and 1.06 (1.02-1.11) for STS-TVR score.
Conclusion:
EuroSCORE II was superior to STS-TVR score at predicting adverse outcomes after isolated TVR. Although risk scores traditionally under-estimated 30-day mortality after isolated TVR, our excellent surgical results meant that calibration of both scores were satisfactory for our cohort, and provides a benchmark for future studies of isolated surgical and transcatheter tricuspid valve procedures.
Comparison of Risk Models at Predicting Outcomes of Isolated Tricuspid Valve Surgery
