The age-adjusted Charlson comorbidity index in minimally invasive mitral valve surgery

Abstract

OBJECTIVES Mitral valve repair is the preferred method used to address mitral valve regurgitation, whereas transcatheter mitral valve repair is recommended for high-risk patients. We evaluated the risk-predictive value of the age-adjusted Charlson comorbidity index (aa-CCI) in the setting of minimally invasive mitral valve surgery. METHODS The perioperative course and 1-year follow-up of 537 patients who underwent isolated or combined minimally invasive mitral valve surgery were evaluated for 1-year mortality as the primary end point and other adverse events. The predictive values of the EuroSCORE II and STS score were compared to that of the aa-CCI by a comparative analysis of receiver operating characteristic curves. Restricted cubic splines were applied to find optimal aa-CCI cut-off values for the increased likelihood of experiencing the predefined adverse end points. Consequently, the perioperative course and postoperative outcome of the aa-CCI ≥8 patients and the remainder of the sample were analysed. RESULTS The predictive value of the aa-CCI does not significantly differ from those of the EuroSCORE II or STS score. Patients with an aa-CCI ≥8 were identified as a subgroup with a significant increase of mortality and other adverse events. CONCLUSIONS The aa-CCI displays a suitable predictive ability for patients undergoing minimally invasive mitral valve surgery. In particular, multimorbid or frail patients may benefit from the extension of the objectively assessed parameters, in addition to the STS score or EuroSCORE II. Patients with an aa-CCI ≥8 have a very high surgical risk and should receive very careful attention.

Charlson Comorbidity Index: A Critical Review of Clinimetric Properties

“…In 330 spinal cord injured patients, Rochon et al [82] compared a count of ICD diagnostic codes and the CCI, and found that both predicted 18-month mortality, yet the Charlson Index outperformed the ICD diagnostic codes. In mitral valve patients undergoing minimally invasive surgery, the CCI and the Society for Thoracic surgeons score were highly correlated; both predicted 1-year mortality [83].…”

LV function or geometry assessment for mitral valve surgery?

“…In the process of decision making for surgical indication, it is important to consider patient comorbidities in addition to preoperative LVEF values of 30%–60% as this can also affect the outcomes of MIMVS. Minol et al 10 assessed the risk‐predictive value of the age‐adjusted Charlson comorbidity index (aa‐CCI) in MIMVS. They reported that patients with an aa‐CCI score ≥ 8 carry a substantially increased risk of mortality and adverse events 10 .…”

“…Minol et al 10 assessed the risk‐predictive value of the age‐adjusted Charlson comorbidity index (aa‐CCI) in MIMVS. They reported that patients with an aa‐CCI score ≥ 8 carry a substantially increased risk of mortality and adverse events 10 . Therefore, the aa‐CCI score should be considered when assessing elderly patients with multimorbidities for MIMVS, in addition to the EuroSCORE II that is traditionally used 10 …”

“…They reported that patients with an aa-CCI score ≥ 8 carry a substantially increased risk of mortality and adverse events. 10 Therefore, the aa-CCI score should be considered when assessing elderly patients with multimorbidities for MIMVS, in addition to the EuroSCORE II that is traditionally used. 10 Overall, LVEF is not the sole parameter in determining patient outcome in MIMVS.…”

“…10 Therefore, the aa-CCI score should be considered when assessing elderly patients with multimorbidities for MIMVS, in addition to the EuroSCORE II that is traditionally used. 10 Overall, LVEF is not the sole parameter in determining patient outcome in MIMVS. Other factors that can impact LV function includes LV geometry, LV mass, LV volumes, patient comorbidities, and other concomitant procedures taking place with mitral valve procedures.…”