Scoring Systems for Predicting Mortality After Valve Surgery

Main Risk Stratification Systems

The European Society of Cardiology recommends using the EuroSCORE, a widely used and validated scoring system for predicting mortality after valve surgery, with both additive and logistic versions available 1, 2
The Society of Thoracic Surgeons (STS) score is another widely used system, specifically designed for valve surgery with 24 covariates, making it more specific to valve heart disease but less user-friendly than EuroSCORE 2, 4

The European Society of Cardiology identifies patient-related factors, including age, female sex, chronic pulmonary disease, extracardiac arteriopathy, neurological dysfunction, previous cardiac surgery, serum creatinine levels, active endocarditis, and critical preoperative state, as contributing to the EuroSCORE 1, 3, 5, 6
The American College of Cardiology notes that cardiac-related factors, such as unstable angina, left ventricular dysfunction, recent myocardial infarction, and pulmonary hypertension, are also included in the EuroSCORE 1, 3, 6
Operation-related factors, including emergency surgery, surgery on the thoracic aorta, and post-infarct septal rupture, are considered in the EuroSCORE 3, 5, 6

The European Society of Cardiology states that EuroSCORE has demonstrated good discrimination but may have calibration issues, with the logistic EuroSCORE tending to overestimate mortality in high-risk patients 2, 7
The American College of Cardiology recommends that risk scores, such as EuroSCORE, should not be used in isolation but integrated with clinical judgment and other methods of risk assessment 6

The European Society of Cardiology suggests that operative mortality rates vary by procedure type, with combined valve and CABG procedures carrying higher risk than isolated valve procedures 2, 7
The American College of Cardiology notes that underuse of therapeutic intervention in high-risk symptomatic patients despite guideline recommendations is a common pitfall 2, 7