Abstract
model. Classification function coefficients were stratified in quartiles of risk and based on quartiles of coefficients sums, three groups of patients were identified (first + second quartile = 1st group; third quartile = 2nd group; fourth quartile = 3rd group). According to its prevalence in each group, to each factor was then assigned an arbitrary score. Age, pre-operative renal insufficiency, NYHA class III and IV, preoperative mechanical ventilation for pulmonary oedema, emergency surgery, Gram negative endocarditis; and perivalvular involvement (abscess/fistula) were main model variables. Range score from 0 to 2 points defined inclusion in stage 1 (low-risk); 3 to 8 points in stage 2 (average risk); 9 or higher in stage 3 (high-risk). Results: Hospital mortality (overall 9.1%) was: 1.2% in Stage 1 (168 patients), 7.0% in Stage 2 (129 patients), 24.1% in Stage 3 (108 patients) (p < 0.001). Follow-up was 96% complete. Overall actuarial survival was 82%±0.023 at 5 years, 73%±0.03 at 10 years, 59%±0.04 at 15 years. Ten-year survival was 81%, 70%, 59% in stage 1, 2 and 3 respectively (log-rank test: p = 0.002). Conclusions: The newly developed stratification method, computed on clinical preoperative criteria, clearly discriminated patient groups with significantly different in-hospital and long-term prognosis.
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