C.Surgical Procedure; Cardiac Clinical Trial
Official title:
An International Multicenter Prospective Study for Identify High-risk Patients in Cardiac Surgery Procedures: HiriSCORE
Over time there is a need to improve old and develop new risk models. Overall the assessment
of mortality risk in cardiac surgery is performed with the use of preoperative risk models.
The use of improved risk models and increased accuracy in the technique of preparing these
mathematical systems does not have a positive impact on the level of prediction, which is
still inaccurate, especially in the considered group of high risk. New models need to be
built not only for a better prediction of mortality risk, if not also to predict morbidity in
the group of patients at higher risk of complications after cardiac surgery procedures.
The aim of this study is:
- To construct the HiriSCORE to identify patients at higher risk of complications after
cardiac surgery procedures
- Assessing the impact of pre-, intra- and postoperative period to the prognosis of
morbidity and mortality in high-risk patients undergoing cardiac surgery procedures.
The risk predicts models are the mathematical tools for identification of the patients with
complications risk after cardiac surgery procedures.
Over time, however, due to technical progress (the development of hybrid surgery, new valves
and prostheses), the development of new drugs, changes in the environment and social
conditions in which do patients live, there is a need to improve old and develop new models.
Based on the statement that high risk patients have similar characteristics (clinical and
laboratory) regardless of the procedure to which they were submitted, creating a new risk
score to this group of patients must be sought. Improving the model quality was achieved by
using more accurate risk assessments. In general, the assessment of mortality risk in cardiac
surgery is performed with the use of preoperative risk models (EuroSCORE II, STS-score).
However, the use of improved risk models and increased accuracy in the technique of preparing
these mathematical systems, unfortunately, does not have a positive impact on the level of
prediction, which is still inaccurate, especially in the considered group of high risk. New
models need to be built not only for a better prediction of mortality risk, if not also to
predict morbidity in the group of patients at higher risk of complications after cardiac
surgery procedures.
The aim of this study is:
- To construct the HiriSCORE to identify patients at higher risk of complications after
cardiac surgery procedures (the investigators have proposed a high-risk evaluation
criteria: EuroSCORE II> 5 or STS-score> 5);
- Assessing the impact of pre-, intra- and postoperative period to the prognosis of
subsequent morbidity and mortality in high-risk patients who have passed cardiac surgery
procedures.
It was decided to conduct this research in two phases. The developmental phase is carried out
for 30 months and includes an analysis of at least 2,000 patients who will pass cardiac
surgery procedures in institutions and hospitals involved in the study. After this analysis,
including outcomes, will be constructed the HiriSCORE, a new test-model for high-risk
patients. In the validation phase of the study, which will involve a further 1,000 patients
it is planned preparation and verification of effectiveness of the HiriSCORE model where it
will be compared to the STS Score and the EuroSCORE II.
The study will include the patients of 18 years old or older who have undergone cardiac
surgery procedures, such as coronary artery bypass grafting (isolated or combined with any
heart valve intervention), heart valve surgery, and surgery on the ascending aorta (only
combined with operations on the aortic valve or CABG).
Totally, it is proposed assessment of 170 variables (factors perceived risk) for each patient
(preoperative, intraoperative, and up to 12 hours after surgery).
The study of mortality and postoperative complications such as renal replacement therapy,
stroke, reoperation for bleeding, respiratory failure, cardiogenic shock, will be carried out
within 30 days after cardiac surgery procedures.
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