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Cardiac surgery
How to assess risks of valve surgery: quality, implementation and future of risk models
  1. Menno van Gameren,
  2. Nicolo Piazza,
  3. Ad J J C Bogers,
  4. Johanna J M Takkenberg,
  5. A Pieter Kappetein
  1. Departments of Cardio-Thoracic Surgery and Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Dr A Pieter Kappetein, Department Cardio-Thoracic Surgery, Bd 569, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; a.kappetein{at}erasmusmc.nl

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Risk stratification models for operative mortality have gained widespread acceptance in cardiac surgery.1 These models, however, are not 100% accurate. A number of factors can influence their performance. The introduction of transcatheter aortic valve technology and the need to identify more precisely those patients at high or prohibitive risk for surgery has created awareness among the cardiology and surgical community of the importance to understand the applications and limitations of these risk models.

This review aims to give an overview of currently available risk stratification models intended for patients undergoing cardiac surgery, in particular heart valve surgery, and describe the potential applications of risk models in the clinical and research setting. Model quality will be discussed through critical appraisal of currently available heart valve surgery risk models. Finally future directions are given for the development of heart valve surgery risk models in the context of emerging transcatheter valve therapies.

Available risk models

Generally speaking, available risk models for cardiac surgery can be divided into three categories: (1) general cardiac surgery models—that is, coronary artery bypass surgery, valve surgery or other related cardiac surgery2 3; (2) general valve surgery models4 5 6 7 8 9 10; and (3) specific aortic valve surgery risk models.11 12

More recently, investigators have developed dedicated risk models for patients undergoing valve surgery with or without concomitant coronary artery bypass surgery.4 5 6 7 8 9 10 11 12 An overview of these risk models is provided in table 1.

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Table 1

Quality aspects of currently used risk stratification models to predict early mortality after valve surgery

Applications of risk stratification models

Risk models can serve multiple purposes if used correctly. Firstly, risk models can be used for benchmarking; they may allow for control of procedural complexity when analysing hospital and surgeon performance. Secondly, risk models can help …

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