Sinzobahamvya Nicodème, Photiadis Joachim, Kumpikaite Daiva, Fink Christoph, Blaschczok Hedwig C, Brecher Anne Marie, Asfour Boulos
Department of Pediatric Thoracic and Cardiovascular Surgery, German Pediatric Heart Center, Sankt Augustin, Germany.
Ann Thorac Surg. 2006 May;81(5):1794-800. doi: 10.1016/j.athoracsur.2005.12.009.
Aristotle score is emerging as a reliable tool to measure surgical performance. We estimated the comprehensive Aristotle score for the Norwood procedure, correlated it with survival, and considered its impact on surgical management of hypoplastic left heart syndrome.
Comprehensive Aristotle score was retrospectively calculated for 39 consecutive Norwood procedures performed from 2001 to 2004. Survival was estimated by the Kaplan-Meier method.
The Aristotle scores ranged from 14.5 to 23.5 (mean, 19.12 +/- 2.52; median, 19.5). The score was 20 or greater in 44% (17 of 39) of cases. The most frequent patient-adjusted factors were aortic atresia (n = 16), interrupted aortic arch (n = 9), mechanical ventilation to treat cardiorespiratory failure (n = 19) and shock resolved at time of surgery (n = 13). Hospital mortality was 58.8% (10 of 17) in case of score of 20 or more and 9.1% (2 of 22) for score less than 20 (p = 0.0014). From 2003 on, all patients with a score less than 20 survived. Actuarial estimate of survival at 1 year is 56.2% +/- 7.9% and there have been no late deaths after 1 year. One-year survival is much lower (p = 0.001) for patients with scores of 20 or greater (29.4% +/- 11.05%) compared with those whose scores were less than 20 (77.3% +/- 8.9%).
This study shows significant correlation of comprehensive Aristotle score with hospital mortality and late survival after Norwood palliation. It suggests that operative survival on the order of 90% may be achieved in patients with comprehensive complexity scores of less than 20. Efforts should be devoted to improve survival of high-risk patients (score > or = 20).
亚里士多德评分正逐渐成为衡量手术表现的可靠工具。我们估算了诺伍德手术的综合亚里士多德评分，将其与生存率相关联，并探讨了其对左心发育不全综合征手术治疗的影响。
对2001年至2004年连续进行的39例诺伍德手术进行回顾性计算综合亚里士多德评分。采用Kaplan-Meier法估算生存率。
亚里士多德评分范围为14.5至23.5（均值为19.12±2.52；中位数为19.5）。44%（39例中的17例）的病例评分在20分及以上。最常见的患者调整因素为主动脉闭锁（n = 16）、主动脉弓中断（n = 9）、因心肺衰竭进行机械通气（n = 19）以及手术时休克已缓解（n = 13）。评分在20分及以上的病例中，医院死亡率为58.8%（17例中的10例），评分低于20分的病例中，医院死亡率为9.1%（22例中的2例）（p = 0.0014）。从2003年起，所有评分低于20分的患者均存活。1年时的精算生存率估计为56.2%±7.9%，1年后无晚期死亡病例。评分在20分及以上的患者1年生存率（29.4%±11.05%）显著低于评分低于20分的患者（77.3%±8.9%）（p = 0.001）。
本研究表明诺伍德姑息手术后综合亚里士多德评分与医院死亡率及晚期生存率显著相关。这表明综合复杂性评分低于20分的患者手术生存率可能达到90%左右。应致力于提高高危患者（评分≥20分）的生存率。
