Menon Ares K, Mechelinck Mare, Unterkofler Jan, Goetzenich Andreas, Autschbach Rüdiger, Tewarie Lachmandath, Moza Ajay
Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
Thorac Cardiovasc Surg. 2016 Sep;64(6):475-82. doi: 10.1055/s-0035-1565001. Epub 2015 Oct 26.
Background Left ventricular assist devices (LVADs) are nowadays a widespread option for the effective treatment of heart failure. We hypothesized that the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) might be a superior tool in clinical decision making compared with other established score systems. Methods In this retrospective, single-center analysis, between 2008 and 2014, 40 consecutive patients were followed for up to 36 months after LVAD (Thoratec HeartMate II) implantation. Postoperative survival was correlated to the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) levels, Destination Therapy Risk Score (DTRS), HeartMate II Risk Score (HMRS), and EuroSCORE II. Results Overall, a positive outcome (survival, transplantation, or weaning) was reached in 87.5% (30 days), 70% (1 year), and 60% (2 and 3 years) of cases. Patients were categorized as high, medium, and low risk by use of the different scores. Within the created subgroups, the following 1-year positive outcomes were achieved-INTERMACS: high risk 58% versus low risk 68%; EuroSCORE II: high risk 17% versus low risk 89%; DTRS: high risk 44% versus low risk 75%; and HMRS: high risk 60% versus low risk 100%. After 1 year, the EuroSCORE II classification's area under the receiver operating characteristic curve (AUC) was superior (AUC = 0.78) and Fisher exact test revealed a significant predictive value for this classification (p = 0.0037) but not for INTERMACS levels, DTRS, or HMRS classifications. Conclusion These results support the assumption that EuroSCORE II risk classification may be useful to predict survival in LVAD patients. In our observation, it proved to be superior to INTERMACS, DTRS, and HMRS after 1 year.
背景 左心室辅助装置（LVADs）如今是治疗心力衰竭的一种广泛应用的有效选择。我们假设，与其他既定的评分系统相比，欧洲心脏手术风险评估系统II（EuroSCORE II）可能是临床决策中的一种更优工具。方法 在这项回顾性单中心分析中，2008年至2014年间，对40例连续接受LVAD（Thoratec HeartMate II）植入术的患者进行了长达36个月的随访。术后生存率与机构间机械辅助循环支持注册系统（INTERMACS）分级、目标治疗风险评分（DTRS）、HeartMate II风险评分（HMRS）以及EuroSCORE II相关。结果 总体而言，87.5%（30天）、70%（1年）以及60%（2年和3年）的病例获得了阳性结果（生存、移植或撤机）。通过使用不同的评分将患者分为高、中、低风险组。在创建的亚组中，以下是1年时的阳性结果——INTERMACS：高风险组为58%，低风险组为68%；EuroSCORE II：高风险组为17%，低风险组为89%；DTRS：高风险组为44%，低风险组为75%；HMRS：高风险组为60%，低风险组为100%。1年后，EuroSCORE II分类的受试者工作特征曲线下面积（AUC）更优（AUC = 0.78），Fisher精确检验显示该分类具有显著的预测价值（p = 0.0037），但对于INTERMACS分级、DTRS或HMRS分类则不然。结论 这些结果支持了EuroSCORE II风险分类可能有助于预测LVAD患者生存率的假设。在我们的观察中，1年后它被证明优于INTERMACS、DTRS和HMRS。
