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Original research article
Validation of the grown-ups with congenital heart disease score
  1. Jürgen Hörer1,
  2. Régine Roussin1,
  3. Emanuel LeBret1,
  4. Mohamed Ly1,
  5. Jarrah Abdullah1,
  6. Rafaella Marzullo1,
  7. Jelena Pabst von Ohain2,
  8. Emre Belli1
  1. 1 Department of Pediatric Cardiology and Congenital Heart Disease, Hopital Marie Lannelongue, Université Paris-Sud, Le Plessis Robinson, France
  2. 2 Department of Cardiovascular Surgery, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
  1. Correspondence to Professor Jürgen Hörer, Department of Pediatric Cardiology and Congenital Heart Disease, Hopital Marie Lannelongue, Université Paris-Sud, 92350 Le Plessis Robinson, France; hoererjs{at}


Objectives Adults with congenital heart disease in need of heart surgery frequently present with significant comorbidity. Furthermore, additional technical difficulties often related to redo operations increase the risk for postoperative mortality and morbidity. Hence, next to the type of the procedure, additional procedure-dependent and procedure-independent factors have to be considered for risk evaluation. The recently proposed grown-ups with congenital heart disease (GUCH) mortality and morbidity scores account for these additional risk factors. We sought to validate their predictive power in a large population operated in a single centre.

Methods Data of all consecutive patients aged 18 years or more, who underwent surgery for congenital heart disease between 2005 and 2016, were collected. Mortality was defined as hospital mortality or mortality within 30 days following surgery. Morbidity was defined as occurrence of one or more of the following complications: renal failure requiring dialysis, neurologic deficit persisting at discharge, atrioventricular block requiring permanent pacemaker implantation, mechanical circulatory support, phrenic nerve injury and unplanned reoperation. The discriminatory power of the GUCH scores was assessed using the area under the receiver operating characteristics curve (c-index, including 95% CI).

Results Eight hundred and twenty-four operations were evaluated. Additional procedure-dependent and procedure-independent factors, as defined in the GUCH scores, were present in 165 patients (20.0%) and 544 patients (66.0%), respectively. Hospital mortality and morbidity was 3.4% and 10.0%, respectively. C-index for GUCH mortality score was 0.809 (0.742–0.877). C-index for GUCH morbidity score was 0.676 (0.619–0.734).

Conclusions We could confirm the good predictive power of the GUCH mortality score for postoperative mortality in a large population of adults with congenital heart disease.

  • congenital heart disease surgery
  • complex congenital heart disease

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  • Contributors RR, JPO and EB have substantially contributed to the design of the study, to analysis and interpretation of the data. ELB, ML, JA and RM have contributed in the acquisition of data and in interpretation of results. All coauthors have contributed in revising the manuscript critically and in approval of the final version. All coauthors agree to be accountable for all aspects of the work.

  • Competing interests None declared.

  • Ethics approval Institutional Review Board approval was obtained to conduct this retrospective study.

  • Provenance and peer review Not commissioned; externally peer reviewed.