Clinical prediction rule for 30-day mortality in Björk-Shiley convexo-concave valve replacement

We aimed to develop a clinical prediction rule for 30-day mortality in patients undergoing Björk-Shiley convexo-concave (BScc) valve replacement, based on primary valve implantation procedures. We studied 30-day mortality in 2,263 patients who received a BScc valve between 1979 and 1985 in The Nethe...

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Bibliographic Details
Published in:Journal of clinical epidemiology 2003-10, Vol.56 (10), p.1006-1012
Main Authors: van Gorp, M.J., Steyerberg, E.W., Kallewaard, M., van der Graaf, Y.
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Björk-Shiley convexo-concave valves
Cardiovascular disease
Clinical prediction rule
Coronary Disease - complications
Coronary vessels
Emergencies
Epidemiology
Follow-Up Studies
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - mortality
Humans
Logistic Models
Medical sciences
Middle Aged
Models, Statistical
Mortality
Netherlands - epidemiology
Operative mortality
Prognosis
Prostheses
Prosthetic heart valves
Reoperation
Risk Assessment
Risk Factors
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
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Summary:We aimed to develop a clinical prediction rule for 30-day mortality in patients undergoing Björk-Shiley convexo-concave (BScc) valve replacement, based on primary valve implantation procedures. We studied 30-day mortality in 2,263 patients who received a BScc valve between 1979 and 1985 in The Netherlands. A logistic regression model was constructed and internally validated with bootstrapping techniques. Predictors for mortality were emergency operation, coronary artery disease, mitral or double-valve replacement, BScc implant being a reoperation, endocarditis, poor left ventricular function, age, concomitant tricuspid valve plasty, and aortic root replacement. The area under the receiver operating characteristic curve (AUC) for the predicted probability of death was 0.76 (95% CI 0.72–0.80). The model calibrated well, and had adequate discriminative ability in 195 BScc valve patients who underwent explantation, including 53 prophylactic explantations (AUC 0.81, 95% CI 0.73–0.89). A prediction rule derived from BScc valve implantation data performed well in patients undergoing explantation. Because the model provides accurate individualized estimates of the risk of mortality after reoperation, it may be helpful for decision making in patients with BScc valves.
ISSN:0895-4356
1878-5921
DOI:10.1016/S0895-4356(03)00172-0