Competence of the European System for Cardiac Operative Risk Evaluation II to predict operative mortality in acute type A aortic dissection surgery.

Abstract

Until recently the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II [1] was the only on-line available risk calculator, which enabled calculation of predicted operative risk for thoracic aorta surgery. Nishida et al. [2] were the first who validated the EuroSCORE II to predict operative mortality for 461 patients who underwent surgery of the thoracic aorta during a 20-year period (1993–2013). One hundred and thirty-three patients (28.9% of the whole cohort) underwent surgery for acute type A acute aortic dissection (ATAAD), with reported mortality of 9%. The area under the receiver operating characteristic curve confirmed very good discriminatory power (area under the receiver operating characteristic curve = 0.77) for the whole sample, with good calibration (overall in-hospital mortality rate 7.2%, overall predicted mortality by EuroSCORE II of 7.4%). If you use terms EuroSCORE II and acute type A aortic dissection to search MEDLINE (https://www.ncbi.nlm.nih.gov/pubmed) through the December 2021, you will find that in at least 10 articles EuroSCORE II was used to predict mortality in ATAAD surgery. The EuroSCORE II was used to predict operative mortality in ATAAD surgery, even in the most recent one (June 2021), reported by the authors [3] from Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus, Kiel, Germany—the participating centre of the German Registry of Acute Aortic Dissection Type A (GERAADA). Salem et al. [3] presented retrospective analysis of 344 patients who underwent surgery for ATAAD over 15 years (2001–2016). Surprisingly, EuroSCORE II, but not on-line GERAADA score, was used to predict operative mortality. Thirty-day survivors had significantly lower EuroSCORE II compared with 30-day deceased patients, 4.63% vs 15.4% (P < 0.001), respectively.