Evaluation of mortality scores in patients with adult congenital heart defects

Abstract

Objectives: Currently, there is no approved risk stratification for adult congenital heart surgery; accordingly, this study aimed to evaluate risk stratification for congenital heart surgery in the pediatric age in terms of its prognostic value in adult patients as well as the effectiveness of the newly developed Adult Congenital Heart Surgery (ACHS) score in this patient group. Patients and methods: A total of 205 patients (115 males, 90 females; mean age: 25.0±11.4 years; range, 18 to 65 years) operated on due to congenital heart disease between January 1, 2011, and August 1, 2019, were studied retrospectively. Aristotle Basic Complexity (ABC) score, Society of Thoracic Surgery European Association for Cardiothoracic Surgery (STAT) score, and ACHS score were evaluated. Receiver operating characteristic (ROC) curves were created to evaluate the ability of scoring systems to predict mortality. Results: The mortality rate was 4.4% (n=9). For mortality, areas under the ROC curve were 0.89, 0.89, and 0.70 for ABC, STAT, and ACHS scores, respectively. The mean ACHS score was 0.42±0.34. The cut-off point of the ACHS score was identified as 0.7 and above. The specificity of the cut-off value of 0.7 regarding the ACHS score was 94.39%. Adult Congenital Heart Surgery scores were found to be statistically high in patients with mortality (p=0.037; p<0.05). Conclusion: Adult Congenital Heart Surgery scores had higher specificity in determining mortality in cases with an ACHS score of 0.7 and above. The ACHS score could also be used to determine the expected mortality rate, similar to the ABC and STAT scores.