MODERN MODELS OF RISK STRATIFICATION OF CARDIAC OPERATIONS



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Abstract

To provide more accurate stratification models, one should systematically review the figures. In 2010, there was a re-organized multicenter study team of researchers from Papworh Hospital (Cambridge, UK). The project EuroScore II involved 154 centers from 43 countries. One of three Russian centers participating in the project was the Department of Cardiac Surgery of the City Hospital N 1 named after E. E. Volosevitch, Arkhangelsk. Purpose. Participation in a multicenter study EuroScore II for development of modern models of risk stratification of cardiac operations. Methods. There were examined 113 patients over 18 y.o. operated in May-June 2010. Complicated (nonlethal) postoperative period in patients who underwent myocardial revascularization, was observed in 19.5 % of cases, heart valves replacement / repair - in 21.1 %, the combined procedure - in 45.5 %, ascending aorta and aortic arch replacement / repair - in 0 % of cases respectively. Predicted hospital mortality among the patients who underwent myocardial revascularization was 3.7 %, heart valves replacement / repair - 5.3 %, the combined procedure - 18.2 %, ascending aorta and aortic arch repair - 100 % respectively. Conclusions. Use of scale EuroScore I may become less relevant, because there is an expansion of indications for cardiac surgery, due to improved surgical techniques, anesthesia and technical equipment provision. Scale EuroScore II may allow better assessment of cardiac surgery risk.

Full Text

Шкала EuroScore была предложена в 1999 году для оценки риска при кардиохирургических операциях группой исследователей из Papworth Hospital (Cambridge, UK) [1, 3]. Шкала основана на данных обширного исследования, в котором участвовали 19 030 оперированных на сердце пациентов из разных стран Европы (1999 г.). Было изучено влияние на смертность 68 предоперационных и 29 интраоперационных факторов. Средний возраст обследуемых составил (62,5 ± 10,7) года (от 17 до 94 лет). Наиболее распространенными факторами риска были: артериальная гипертензия (у 43,6 % обследованных пациентов), диабет (16,7 %), атеросклероз периферических артерий (2,9 %), хроническая почечная недостаточность (3,5 %), хронические заболевания легких (3,9 %), предшествовавшие вмешательства на сердце (7,3 %), дисфункция левого желудочка (31,4 %). У 63,6 % пациентов были выполнены операции на сердце, у 29,8 % - операции на клапанах сердца. Общая госпитальная смертность составляла 4,8 %, смертность от кардиологических причин - 3,4%.
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About the authors

A N Shonbin

City Hospital N 1 named after E. Volosevitch; Northern State Medical University

Arkhangelsk, Russia

D Olegovich Bystrov

City Hospital N 1 named after E. Volosevitch; Northern State Medical University

Email: dr.bystrov@gmail.com
Arkhangelsk, Russia

A S Zavolojin

City Hospital N 1 named after E. Volosevitch

Arkhangelsk, Russia

B L Duberman

City Hospital N 1 named after E. Volosevitch; Northern State Medical University

Arkhangelsk, Russia

M V Elizarov

City Hospital N 1 named after E. Volosevitch

Arkhangelsk, Russia

M A Yarkovoy

City Hospital N 1 named after E. Volosevitch

Arkhangelsk, Russia

References

  1. EuroSCORE predicts health-related quality of life after coronary artery bypass grafting / P. Loponen, M. Luther, J. Nissinen, et al. // Interactive Cardiovascular and Thoracic Surgery. 2008. Vol. 7. P. 564-568.
  2. Hirose H. The role of EuroSCORE in patients undergoing off-pump coronary artery bypass // Interact. Cardiovasc. Thorac. Surg. 2010. Vol. 10(5). P. 771-776. Epub 2010 Jan 26.
  3. Yap C. H., Reid C., Yii M., Rowland M. A., Mohajeri M., Skillington P. D., Seevanayagam S., Smith J. A. Validation of the EuroSCORE model in Australia // Eur. J. Cardiothorac. Surg. 2006. Vol. 29. P. 441-446.
  4. EuroSCORE predicts health-related quality of life after coronary artery bypass grafting / P. Loponen, M. Luther, J. Nissinen, et al. Interactive Cardiovascular and Thoracic Surgery. 2008; 7: 564-568.
  5. Hirose H. The role of EuroSCORE in patients undergoing off-pump coronary artery bypass. Interact Cardiovasc Thorac Surg. 2010 May;10(5): 771-776. Epub 2010 Jan 26.
  6. Yap C. H., Reid C., Yii M., Rowland M. A., Mohajeri M., Skillington P. D., Seevanayagam S., Smith J. A. Validation of the EuroSCORE model in Australia. Eur J Cardiothorac Surg. 2006; 29: 441-446.

Copyright (c) 2012 Shonbin A.N., Bystrov D.O., Zavolojin A.S., Duberman B.L., Elizarov M.V., Yarkovoy M.A.

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