Risk factors for early mortality after valve surgery in Europe in the 1990s: Lessons from the EuroSCORE pilot program

Background and aim of the study: The characteristics of valve surgery are e volving. The study aim was to explore its demographics and risk factors in Europe in the 1990s, using the EuroSCORE database. Methods: For the EuroSCORE program, information on 98 variables regarding r isk factors, procedures and outcome were collected for 5,672 patients under going valve surgery under cardiopulmonary bypass in 128 European centers. B ivariate (i.e. Mann-Whitney test or chi-square when appropriate), then logi stic regression analyses were carried out to identify risk factors for earl y mortality. The predictive value of EuroSCORE was analyzed using the Hosme r-Lemershow test and by computing the area under the receiver operating cha racteristic (ROC) curve. Results: Aortic valve stenosis was the most common diagnosis (47.6%), whils t mitral valve surgery accounted for 42% of procedures. Coronary surgery wa s performed concomitantly in 21% of cases. Hospital mortality was 6.1%. Pre dictive factors for early mortality were: age (p = 0.0001), preoperative se rum creatinine > 200 pmol/l (p = 0.014), previous heart surgery (p = 0.0001 ), poor left ventricular function (p = 0.008), chronic congestive heart fai lure (p = 0.0001), pulmonary hypertension (p = 0.0001), active acute endoca rditis (p = 0.0001), emergency procedure (p = 0.05), critical preoperative status (p = 0.0001), tricuspid surgery (p = 0.015), aortic and mitral surge ry (p = 0.002), combined thoracic surgery (p = 0.0001), and combined corona ry surgery (p = 0.0001). The predictive value of EuroSCORE for mortality wa s good (area under the ROC curve = 0.75). Conclusion: The 'valve' subset of the EuroSCORE database provides an instan t picture of European valve surgery in the 1990s that can be used either fo r individual assessment, or for country- or institution-based epidemiologic al studies of risk factors and practices.