心脏瓣膜手术风险预测系统的建立
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摘要
【目的】
本课题利用我国心脏瓣膜外科治疗数据库，对国内四个心脏外科中心3年间成人心脏瓣膜手术病例资料进行回顾性分析，评价EuroSCORE II、STS2008及SinoSCORE三个心脏风险预测模型对本数据库内患者术后死亡的预测准确度，并借鉴这些已有模型的构建方法，建立我国成人心脏瓣膜病手术风险预测模型并在四个心脏中心中进行验证。
【方法】
（一）多中心成人心脏瓣膜手术现状分析：
1、选择国内四个心脏外科中心2006年1月至2008年12月间行瓣膜手术，年龄≥18岁患者作为研究对象，排除年龄小于18岁患者323例，排除关键信息缺失（包括手术类型、性别、手术日期、出院状态）患者79例，最终入选11774例。包括同期行冠状动脉搭桥（CABG）手术、同期大血管手术、同期先天性心脏病矫治手术的患者。
2、分别按年份及心脏中心不同分别分为3组（2006－2008共3年）及4组（4个中心共四组），分别比较不同年度、不同中心患者情况的差别，判断差异是否有统计学意义。
（二）现有心脏手术风险预测模型用于我国心脏手术患者死亡风险的验证研究：
1、入选患者与第一部分相同，选取术后院内死亡为终点事件，选取目前国外应用最广泛的风险预测模型EuroSCORE II、STS2008心脏手术风险预测模型及我国的多中心CABG手术风险模型SinoSCORE进行验证，评价上述三个心脏手术风险预测模型对我国心脏瓣膜手术的风险预测效力。
2、首先将各患者术前状态及手术情况分别按照EuroSCORE II、STS2008及SinaSCORE的风险因素定义分别编码，按照各模型的logistic回归方程分别计算各患者的预期死亡概率。
3、应用C-统计量及Hosmer-Lemeshow检验分别计算各模型的区别度和校准度。应用观察死亡率/预期死亡率明确各模型对患者整体死亡率的估计偏差。
（三）心脏瓣膜手术风险预测模型的建立：
1、入所患者同第一部分。收集入选患者可能与手术死亡相关的术前临床资料，选择患者术后院内死亡作为终点事件。对各危险因素进行适当编码，并进行单因素logistic回归分析，完成危险因素的初步筛选。
2、将入选患者随机分为建模亚库（占全体70%）和验证亚库（占全体30%），应用建模亚库数据建立模型：将与术后死亡可能相关的危险因素进行多因素logistic回归分析建立瓣膜手术风险预测模型。
3、在验证亚库、总体患者中分别进行验证，观察实验死亡率与预期死亡率的对比检验模型的总体预测能力，即通过Hosmer-Lemeshow检验反映模型的符合程度，通过C-统计量反映模型的鉴别效度，应用观察死亡率/预期死亡率明确模型对患者整体死亡率的估计偏差。
4、根据logistic模型中各风险因素的权重系数β建立简易的评分模型，并计算出各评分分值对应的预期死亡率。同时对评分模型在建模亚库、验证亚库、患者整体分别进行验证。
（四）心脏瓣膜手术风险预测模型在各中心患者群中的验证：
1、入所患者同第一部分。以术后院内死亡为终点事件。
2、对本研究所建立的logistic风险模型及评分模型、STS2008、EuroSCOREII、SinoSCORE在各心脏中心患者群中分别进行验证。
【结果】
（一）多中心成人心脏瓣膜手术现状分析：
1、年度间比较：接受心脏瓣膜手术的患者数量呈逐年上升趋势。患者的身高、体重年度构成等变化不明显；无伴随症状的手术患者及NYHA心功能分组I、II级的患者比例有增加的趋势；术前吸烟，合并有高血压、高脂血症患者的比例明显增加；术前接受多巴胺、洋地黄类药物、利尿剂的患者比例呈上升趋势。手术方式方面，除了主动脉瓣置换术比例逐年增加而三尖瓣成形术减少外，其它瓣膜手术所占比例基本稳定。术后心功能支持方面，肾上腺素及去甲肾上腺素、苯肾上腺素的使用率整体有减少的趋势；磷酸二脂酶抑制剂的应用率有轻微增加的趋势。患者术后应用血液制品的比例略呈增加趋势，但单个患者的血液制品用量呈下降趋势。3年来瓣膜手术患者院内死亡率明显下降。术后患者的呼吸机辅助呼吸时间、ICU停留时间均有缩短。
2、不同中心患者比较：四个中心患者的年龄、身高、体重及性别构成方面，A中心患者平均年龄更低，D中心患者平均身高及体重更低，性别构成差异不明显。A中心的无症状心脏瓣膜手术患者比例高于其余三家医院。从心脏瓣膜病变情况来看，二尖瓣狭窄、二尖瓣关闭不全及主动脉瓣关闭不全是各心脏中心最常见的心脏瓣膜病变类型，而各心脏中心各瓣膜手术所占的比重略有不同。术后患者死亡率的中心间差异明显，C中心的术后死亡率最高而A中心最低；术后并发症的发生比例各中心存在差异，其中术后室颤发生率、心包填塞、肺部感染、
脑卒中、胸骨哆开的发生率中心间差异无统计学意义。（二）现有心脏手术风险模型用于预测我国心脏手术患者死亡风险的研究：
1、模型符合程度：全组11774例患者中术后在院死亡237例，实际在院死亡率为2%。EuroSCOREⅡ、STS2008、SinoSCORE评分方法预测在院死亡率分别为2.63%、1.27%、2.83%，观察/预期死亡比（O/E比）分别为0.77、1.58、0.71。该结果提示三种心脏手术风险预测模型对心脏瓣膜手术总体在院死亡的预测符合程度均较差，EuroSCOREⅡ、SinoSCORE高估了死亡风险，STS2008低估了死亡风险，从H-L检验的结果来看，三者中EuroSCOREⅡ的预测符合度最佳，STS2008的预测符合度最差。
2、模型鉴别效度：EuroSCOREⅡ、STS2008、SinoSCORE三个风险预测模型的C-统计量，即ROC曲线下面积（AUC）分别为0.715，0.685和0.752。EuroSCORE II与SinoSCORE两个模型的C-统计量大于0.7，对患者整体死亡发生与否的预测则表现出较好的区分能力，而STS2008对患者整体预测区分能力不佳。
3、对单瓣手术与联合瓣膜手术预测能力的比较： SinoSCORE对单瓣手术与联合瓣膜手术的鉴别效度均较好，对单瓣手术预测结果略优于联合瓣膜手术（C-统计量分别为0.761，0.746）；EuroSCOREⅡ与STS2008模型对单瓣手术患者的风险鉴别效度均优于对联合瓣膜手术患者的鉴别效度（C-统计量分别为仅STS2008模型对单瓣手术的符合度佳（H－L检验P>0.05）。
（三）我国成人心脏瓣膜手术风险预测模型的建立：
1、所建立的风险预测模型共纳入16个危险因素，分别为：年龄（OR：1.21）、女性（OR：1.38）、体表面积<1.5m2（OR：1.78）；吸烟（OR：1.54）、高血压（OR：1.64）、肾功能衰竭（OR：6.59）、瓣膜手术史（OR：2.23）；左室射血分数<40%（OR：3.86）、重度肺动脉高压（OR：7.27）、三尖瓣重度关闭不全（OR：1.98）；心功能NYHA分级Ⅲ级（OR：3.01）、心功能NYHA分级Ⅳ级（OR：7.04）、术前危重状态（OR：4.82）、冠状动脉病变数量（OR：1.56）；联合瓣膜手术（OR：1.96）、同期行CABG术（OR：7.98）。
2、建模亚库、验证亚库及整体的Hosmer-Lemeshow卡方检验的P值均分别为0.46、0.16、0.63，均大于0.05，提示符合程度良好，C-统计量分别为0.827、0.763、0.810，建模亚库及整体均大于0.80，提示已建立的风险预测模型在本研究所纳入的患者群中具有很好的鉴别效度，其预测准确性好。应用四个心脏中心患者数据分别进行验证提示符合程度和鉴别效度均良好。
3、评分模型：针对上述logistic模型，建立了一套简易的评分模型，具体如下：年龄超过65岁（每岁0.5分）、女性（1分）、体表面积<1.5m2（1.5分）；吸烟（1分）、高血压（1.5分）、肾功能衰竭（5分）、瓣膜手术史（2分）；左室射血分数<40%（4分）、重度肺动脉高压（5.5分）、三尖瓣重度关闭不全（2分）；心功能NYHA分级Ⅲ级（3分），NYHA分组Ⅳ级（5.5分）、术前危重状态（4分）、冠状动脉病变数量（每支1分）；联合瓣膜手术（2分）、同期行CABG术（6分）。对各患者应用评分模型计算了相应的预期死亡风险。该评分模型对患者总体的O/E值1.11，C-统计量为0.808，H-L检验P＝0.28。总体预测符合程度良好。应用四个心脏中心患者数据分别进行验证提示符合程度和鉴别效度均良好。
（四）心脏瓣膜手术风险预测模型在各中心患者群中的验证：
1、logistic风险模型与评分模型在各心脏中心患者群中预测效力基本接近。
2、本研究所建立的瓣膜手术风险模型在各心脏中心患者群中对术后死亡的预测能力优于STS2008、EuroSCOREⅡ及SinoSCORE。
【结论】
1、本研究通过对我国四个心脏外科中心2006-2008年所有心脏瓣膜手术患者共11774例的临床资料进行分析，得到了目前我国心脏瓣膜手术患者的各项详细指标，通过年度间比较及中心间比较，明确了这些临床指标的中心间差异及年度间变化。
2、通过将我国多中心心脏瓣膜手术患者资料应用于国内外知名的心脏手术风险预测模型的验证性研究，明确了EuroSCOREⅡ、STS2008及SinoSCORE模型均不能很好地预测我国成人心脏瓣膜手术后死亡风险，但STS2008模型用于预测单瓣手术患者的术后死亡风险准确度较高。
3、通过借鉴已有的建模方法，本研究建立了适用于我国心脏瓣膜手术患者的风险预测模型，适用人群为所有成人心脏瓣膜手术患者，经内部验证该模型对术后患者死亡的预测准确，可推广应用。
4、通过各中心的验证，本研究所建立的瓣膜手术风险预测模型对各中心患者术后死亡风险预测准确，优于STS2008、EuroSCOREⅡ及SinoSCORE。
【Objective】
This study analyses the clinical character of patients who underwent heart valvesurgery in four cardiac surgery centers in China from Jan.1st,2006to Dec.31,2008retrospectively. The performance of EuroSCORE Ⅱ, STS2008risk model andSinoSCORE for these patients was evaluated. A new adult heart valve operation riskprediction model for Chinese was established upon the data of these patients. Then therisk prediction model was validated in each of the four cardiac center.
【Methods】
1． Current situation of Chinese heart valve surgery-a mulitycenter analysis
1． Patients who underwent heart valve surgery in four cardiac surgicalcenters between Jan.1,2006and Dec.31,2008were included in this study.323patients whose age below18years and79patients who had missing value of keyinformation were excluded. The key information of patients included as surgery types,sex, operative procedure and status of discharge. Patients underwent valve surgerycombined with CABG, arotic surgery, congenital heart surgery were not excluded andresulted a final study group of11774patients.
2． The patients were divided into3and4groups according to the years ofoperation and institutions, respectively. Patients’ clinical characters were comparedamong groups accordingly.
2. Validation of cardiac valve surgery risk models in our patients set:
1． The patient set were the same as that of part one. The endpoint event wasdefined as hospital death. Cardiac surgery risk models listed blew were selected toevaluate their performance in this patient set: EuroSCOREⅡ, STS2008, SinoSCORE.
2． Value of risk factors for every model was obtained for each patient includedin the study. The predicted operative mortality for each patient was calculated by thelogistic regression formular of risk models.
3． Model discrimination was evaluated by c-index and model calibration wasevaluated by Hosmer-Lemeshow good-of-fit test. Observed/Expected mortality (O/E ratio) was calculated to determine the prediction accuracy of each model.
3. Establishment of risk prediction model and risk score for patients underwentadult heart valve surgery:
1． The patient set were the same as that of part one. Potential risk factors forhospital mortality were selected. The endpoint event of the study was hospitalmortality.
2． Univaries logistic regression was performed for all potential risk factors attheir appropriate coding format to reveal their relationship with hospital mortality.Examination for complete separation and multi-collinearity were also performed.
3． The patients set was splited randomly into development set (70%) andvalidation set (30%), and then the risk model was developed using a logisticregression model with backward selection upon the development set. Risk modelderived from the development set was tested in the validation set.
4． Risk score was established upon the logistic regression model. The list ofpredicted mortality to risk score was calculated. Then, this addictive risk model wasvalidated in both development set and validation set.4. Validation of cardiac valve surgical risk prediction model in patients of eachcardiac surgical center.
1. patient set in this part of research was as the patient set of first part. Hospitaldeath was defined as the endpoint.
2. Validation of Logistic risk model as well as the additive model established inprevious study, STS2008, EuroSCORE Ⅱ and SinoSCORE were perform forpatients of each cardiac center.
【Results】
1. Current situation of Chinese heart valve surgery-a mulitycenter analysis:
1． Comparation of patients’ clinical character between operation years. There isan annual increase in case of valve surgery. There is no significant difference aboutweight and height distribution according to the operative year. Asymptomatic patientsand patients with NYHA class Ⅰ/Ⅱ increased by year. Smoking, hypertension, hyperlipidemia also increased by year in the patients set. Preoperative treatment withdopamine, digitalis, and diuretics also became more popular in recent years.Distribution of surgical procedures was relatively constant except for the annualdecreasment of triscupid repairment. The useage of post-operative adrenaline,norepinephrine and phenylephrine were decreased but the useage of phosphodiesteraswas increase. Percentage of patients who had blood transfusion increased but theaverage amount of blood per patients decreased. The hospital mortality, ventilationtime, time of intensive care unit also decreased by year.
2． Comparation between cardiac surgery centers. Gender composition of fourinstitutions was similar and there are more yong patients in Center A. Average heightand weight of patient were significant lower in Center D than those of other Centers.Proportion of asymptomatic patients was higher in Center A than that of other Centers.Mitral stenosis, mitral insufficiency and aortic insufficiency consiste the majority ofvalve lesions in all the four Centers while the composition of valve lesion differs fromeach other. Hospital mortality was high in Center C and low in Center A while theother two was in the middle position. There are differences between institutions forincidence of other operative complications.
2. Validation of published cardiac valve surgery risk models with our patientsset.
1． Model calibration. There are237death in the whole patients set whichresulted a mortality of2%. Expected mortality by the EuroSCOREⅡ, STS2008,SinoSCORE was2.63%,1.27%,2.83%, respectively. Observed mortality/Expectedmortality (O/E ratio) of EuroSCOREⅡ, STS2008, SinoSCORE was0.77,1.58,0.71,respectively. All three cardiac surgery risk models showed poor performance withpatients set of this study. EuroSCOREⅡ and SinoSCORE overestimated hospitalmortality and STS2008underestimated hospital mortality. With theHosmer-Lemeshow good-of-fit test, EuroSCORE Ⅱ had the best performance amongthree models while the STS2008had the worst performance for the whole patients set.
2． Model discrimination. C-index of EuroSCOREⅡ, STS2008, SinoSCORE was0.715,0.685,0.752, respectively. C-index of EuroSCOREⅡand SinoSCOREexceeds0.7means that EuroSCOREⅡand SinoSCORE had better discriminate powerthan STS2008had.
3． Single valve surgery vs. multiple valve surgery. SinoSCORE showed goodmodel discrimination for either Single valve surgery (C-index0.761) or multiplevalve surgery (C-index0.746). EuroSCOREⅡand STS2008risk models were ofbetter discrimination for single valve surgery (C-index0.739,0.721) than that formultiple valve surgery (C-index0.708,0.660). Hosmer-Lemeshow good-of-fit testdemonstrated that only STS2008risk model for the single valve surgery group havegood calibration (P>0.05).
3. Establishment of risk prediction model for adult heart valve surgery:
1． The final risk prediction model included16risk factors: age (OR:1.21),female (OR:1.38), body surface area (OR:1.78), smoking (OR:1.54), hypertension(OR:1.64), renal failure (OR:6.59), previous heart valve surgery (OR:3.86), leftventricular ejection fraction (OR:1.54), severe pulmonary hypertension (OR:7.27),Severe tricuspid regurgitation (OR:1.98); NYHA class Ⅲ (OR:3.01); NYHA class Ⅳ(OR:7.04), preoperative critical state (OR:4.82), number of conary artery disease(OR:1.56); multiple valve surgery (OR:1.96), combined CABG (OR:7.98).
2． The new developed heart valve surgery risk model showed good calibrationand discriminative power for the development set, validation set and the wholepatients set, with the Hosmer–Lemeshow good-of-fit test’s P value of0.46,0.16and0.63, respectively. C-index of the risk model in development set, validation set and thewhole patients set was0.827,0.763and0.810, respectively. The risk model showgood calibration and discrimination power in the whole study population. Thevalidation study of the risk model in the patient set of each cardiac surgery center alsodemonstrated that the model have excellent prediction ability.
3． Based upon the logistic regression model, an additive model was established.Risk score of the additive model listed blow: age (above65years):0.5score per year;femal:1score; body surface area<1.5m2:1.5score, smoking:1score, hypertension: 1.5score, renal failure:5score, previous heart valve surgery:2score, left ventricularejection fraction<40%:4score, severe pulmonary hypertension:5.5score, severtriscupid insuffiency:2score; NYHA class Ⅲ:3score; NYHA class Ⅳ:5.5score,preoperative critical state:4score, number of conary artery disease:1score per vessel,multiple valve surgery:2score, combined CABG:6score. For bedside useage,corresponding predicted mortality to the full range of risk score was also calculated.The additive model’s prediction accuracy was confirmed by validation on the wholepatients set, with O/E ratio of1.11, C-index of0.808and Hosmer–Lemeshowgood-of-fit test’s P value of0.28. The validation of this addictive model for thedevelopment set, validation set and every cardiac surgery center demonstrated thatthe additive model have excellent prediction ability.
4. Validation of cardiac valve surgical risk prediction model in patients of eachcardiac surgical center.
1. Both the logistic risk model and additive risk model have excellent predictionpower for patients of each cardiac surgical center.
2. The new established valve surgical risk model was more suitable forestimating operative mortality after valve surgery than STS2008,EuroSCOREⅡand SinoSCORE.
【Conclusion】
1. This project analyses the clinical character of patients who underwent heartvalve surgery in four cardiac surgery centers from Jan.1st,2006to Dec.31,2008retrospectively. Then the annual changes and hospital level difference of patients’clinical character were identified.
2. EuroSCOREⅡ, STS2008, SinoSCORE were validated by the patients setfrom four Chinese cardiac surgical center. These three cardiac risk models weredemonstrated of poor calibration and reasonable discrimination. STS2008risk modelwas the only risk model suitable for single valve surgery with good calibration andreasonable discrimination.
3. A new adult cardiac risk prediction model and corresponding addictive risk model was developed based on our patients set. This risk model was developed for alladult cardiac valve surgery in China. The inner validation of this risk model showedexcellent performance.
4. Validation study of the new established risk prediction model was performedfor patients of each cardiac center. The risk predition model showed high accuracy inestimating the operative mortialy, and it is better than the STS2008, EuroSCOREⅡand SinoSCORE.
本课题利用我国心脏瓣膜外科治疗数据库，对国内四个心脏外科中心3年间成人心脏瓣膜手术病例资料进行回顾性分析，评价EuroSCORE II、STS2008及SinoSCORE三个心脏风险预测模型对本数据库内患者术后死亡的预测准确度，并借鉴这些已有模型的构建方法，建立我国成人心脏瓣膜病手术风险预测模型并在四个心脏中心中进行验证。
【方法】
（一）多中心成人心脏瓣膜手术现状分析：
1、选择国内四个心脏外科中心2006年1月至2008年12月间行瓣膜手术，年龄≥18岁患者作为研究对象，排除年龄小于18岁患者323例，排除关键信息缺失（包括手术类型、性别、手术日期、出院状态）患者79例，最终入选11774例。包括同期行冠状动脉搭桥（CABG）手术、同期大血管手术、同期先天性心脏病矫治手术的患者。
2、分别按年份及心脏中心不同分别分为3组（2006－2008共3年）及4组（4个中心共四组），分别比较不同年度、不同中心患者情况的差别，判断差异是否有统计学意义。
（二）现有心脏手术风险预测模型用于我国心脏手术患者死亡风险的验证研究：
1、入选患者与第一部分相同，选取术后院内死亡为终点事件，选取目前国外应用最广泛的风险预测模型EuroSCORE II、STS2008心脏手术风险预测模型及我国的多中心CABG手术风险模型SinoSCORE进行验证，评价上述三个心脏手术风险预测模型对我国心脏瓣膜手术的风险预测效力。
2、首先将各患者术前状态及手术情况分别按照EuroSCORE II、STS2008及SinaSCORE的风险因素定义分别编码，按照各模型的logistic回归方程分别计算各患者的预期死亡概率。
3、应用C-统计量及Hosmer-Lemeshow检验分别计算各模型的区别度和校准度。应用观察死亡率/预期死亡率明确各模型对患者整体死亡率的估计偏差。
（三）心脏瓣膜手术风险预测模型的建立：
1、入所患者同第一部分。收集入选患者可能与手术死亡相关的术前临床资料，选择患者术后院内死亡作为终点事件。对各危险因素进行适当编码，并进行单因素logistic回归分析，完成危险因素的初步筛选。
2、将入选患者随机分为建模亚库（占全体70%）和验证亚库（占全体30%），应用建模亚库数据建立模型：将与术后死亡可能相关的危险因素进行多因素logistic回归分析建立瓣膜手术风险预测模型。
3、在验证亚库、总体患者中分别进行验证，观察实验死亡率与预期死亡率的对比检验模型的总体预测能力，即通过Hosmer-Lemeshow检验反映模型的符合程度，通过C-统计量反映模型的鉴别效度，应用观察死亡率/预期死亡率明确模型对患者整体死亡率的估计偏差。
4、根据logistic模型中各风险因素的权重系数β建立简易的评分模型，并计算出各评分分值对应的预期死亡率。同时对评分模型在建模亚库、验证亚库、患者整体分别进行验证。
（四）心脏瓣膜手术风险预测模型在各中心患者群中的验证：
1、入所患者同第一部分。以术后院内死亡为终点事件。
2、对本研究所建立的logistic风险模型及评分模型、STS2008、EuroSCOREII、SinoSCORE在各心脏中心患者群中分别进行验证。
【结果】
（一）多中心成人心脏瓣膜手术现状分析：
1、年度间比较：接受心脏瓣膜手术的患者数量呈逐年上升趋势。患者的身高、体重年度构成等变化不明显；无伴随症状的手术患者及NYHA心功能分组I、II级的患者比例有增加的趋势；术前吸烟，合并有高血压、高脂血症患者的比例明显增加；术前接受多巴胺、洋地黄类药物、利尿剂的患者比例呈上升趋势。手术方式方面，除了主动脉瓣置换术比例逐年增加而三尖瓣成形术减少外，其它瓣膜手术所占比例基本稳定。术后心功能支持方面，肾上腺素及去甲肾上腺素、苯肾上腺素的使用率整体有减少的趋势；磷酸二脂酶抑制剂的应用率有轻微增加的趋势。患者术后应用血液制品的比例略呈增加趋势，但单个患者的血液制品用量呈下降趋势。3年来瓣膜手术患者院内死亡率明显下降。术后患者的呼吸机辅助呼吸时间、ICU停留时间均有缩短。
2、不同中心患者比较：四个中心患者的年龄、身高、体重及性别构成方面，A中心患者平均年龄更低，D中心患者平均身高及体重更低，性别构成差异不明显。A中心的无症状心脏瓣膜手术患者比例高于其余三家医院。从心脏瓣膜病变情况来看，二尖瓣狭窄、二尖瓣关闭不全及主动脉瓣关闭不全是各心脏中心最常见的心脏瓣膜病变类型，而各心脏中心各瓣膜手术所占的比重略有不同。术后患者死亡率的中心间差异明显，C中心的术后死亡率最高而A中心最低；术后并发症的发生比例各中心存在差异，其中术后室颤发生率、心包填塞、肺部感染、
脑卒中、胸骨哆开的发生率中心间差异无统计学意义。（二）现有心脏手术风险模型用于预测我国心脏手术患者死亡风险的研究：
1、模型符合程度：全组11774例患者中术后在院死亡237例，实际在院死亡率为2%。EuroSCOREⅡ、STS2008、SinoSCORE评分方法预测在院死亡率分别为2.63%、1.27%、2.83%，观察/预期死亡比（O/E比）分别为0.77、1.58、0.71。该结果提示三种心脏手术风险预测模型对心脏瓣膜手术总体在院死亡的预测符合程度均较差，EuroSCOREⅡ、SinoSCORE高估了死亡风险，STS2008低估了死亡风险，从H-L检验的结果来看，三者中EuroSCOREⅡ的预测符合度最佳，STS2008的预测符合度最差。
2、模型鉴别效度：EuroSCOREⅡ、STS2008、SinoSCORE三个风险预测模型的C-统计量，即ROC曲线下面积（AUC）分别为0.715，0.685和0.752。EuroSCORE II与SinoSCORE两个模型的C-统计量大于0.7，对患者整体死亡发生与否的预测则表现出较好的区分能力，而STS2008对患者整体预测区分能力不佳。
3、对单瓣手术与联合瓣膜手术预测能力的比较： SinoSCORE对单瓣手术与联合瓣膜手术的鉴别效度均较好，对单瓣手术预测结果略优于联合瓣膜手术（C-统计量分别为0.761，0.746）；EuroSCOREⅡ与STS2008模型对单瓣手术患者的风险鉴别效度均优于对联合瓣膜手术患者的鉴别效度（C-统计量分别为仅STS2008模型对单瓣手术的符合度佳（H－L检验P>0.05）。
（三）我国成人心脏瓣膜手术风险预测模型的建立：
1、所建立的风险预测模型共纳入16个危险因素，分别为：年龄（OR：1.21）、女性（OR：1.38）、体表面积<1.5m2（OR：1.78）；吸烟（OR：1.54）、高血压（OR：1.64）、肾功能衰竭（OR：6.59）、瓣膜手术史（OR：2.23）；左室射血分数<40%（OR：3.86）、重度肺动脉高压（OR：7.27）、三尖瓣重度关闭不全（OR：1.98）；心功能NYHA分级Ⅲ级（OR：3.01）、心功能NYHA分级Ⅳ级（OR：7.04）、术前危重状态（OR：4.82）、冠状动脉病变数量（OR：1.56）；联合瓣膜手术（OR：1.96）、同期行CABG术（OR：7.98）。
2、建模亚库、验证亚库及整体的Hosmer-Lemeshow卡方检验的P值均分别为0.46、0.16、0.63，均大于0.05，提示符合程度良好，C-统计量分别为0.827、0.763、0.810，建模亚库及整体均大于0.80，提示已建立的风险预测模型在本研究所纳入的患者群中具有很好的鉴别效度，其预测准确性好。应用四个心脏中心患者数据分别进行验证提示符合程度和鉴别效度均良好。
3、评分模型：针对上述logistic模型，建立了一套简易的评分模型，具体如下：年龄超过65岁（每岁0.5分）、女性（1分）、体表面积<1.5m2（1.5分）；吸烟（1分）、高血压（1.5分）、肾功能衰竭（5分）、瓣膜手术史（2分）；左室射血分数<40%（4分）、重度肺动脉高压（5.5分）、三尖瓣重度关闭不全（2分）；心功能NYHA分级Ⅲ级（3分），NYHA分组Ⅳ级（5.5分）、术前危重状态（4分）、冠状动脉病变数量（每支1分）；联合瓣膜手术（2分）、同期行CABG术（6分）。对各患者应用评分模型计算了相应的预期死亡风险。该评分模型对患者总体的O/E值1.11，C-统计量为0.808，H-L检验P＝0.28。总体预测符合程度良好。应用四个心脏中心患者数据分别进行验证提示符合程度和鉴别效度均良好。
（四）心脏瓣膜手术风险预测模型在各中心患者群中的验证：
1、logistic风险模型与评分模型在各心脏中心患者群中预测效力基本接近。
2、本研究所建立的瓣膜手术风险模型在各心脏中心患者群中对术后死亡的预测能力优于STS2008、EuroSCOREⅡ及SinoSCORE。
【结论】
1、本研究通过对我国四个心脏外科中心2006-2008年所有心脏瓣膜手术患者共11774例的临床资料进行分析，得到了目前我国心脏瓣膜手术患者的各项详细指标，通过年度间比较及中心间比较，明确了这些临床指标的中心间差异及年度间变化。
2、通过将我国多中心心脏瓣膜手术患者资料应用于国内外知名的心脏手术风险预测模型的验证性研究，明确了EuroSCOREⅡ、STS2008及SinoSCORE模型均不能很好地预测我国成人心脏瓣膜手术后死亡风险，但STS2008模型用于预测单瓣手术患者的术后死亡风险准确度较高。
3、通过借鉴已有的建模方法，本研究建立了适用于我国心脏瓣膜手术患者的风险预测模型，适用人群为所有成人心脏瓣膜手术患者，经内部验证该模型对术后患者死亡的预测准确，可推广应用。
4、通过各中心的验证，本研究所建立的瓣膜手术风险预测模型对各中心患者术后死亡风险预测准确，优于STS2008、EuroSCOREⅡ及SinoSCORE。
【Objective】
This study analyses the clinical character of patients who underwent heart valvesurgery in four cardiac surgery centers in China from Jan.1st,2006to Dec.31,2008retrospectively. The performance of EuroSCORE Ⅱ, STS2008risk model andSinoSCORE for these patients was evaluated. A new adult heart valve operation riskprediction model for Chinese was established upon the data of these patients. Then therisk prediction model was validated in each of the four cardiac center.
【Methods】
1． Current situation of Chinese heart valve surgery-a mulitycenter analysis
1． Patients who underwent heart valve surgery in four cardiac surgicalcenters between Jan.1,2006and Dec.31,2008were included in this study.323patients whose age below18years and79patients who had missing value of keyinformation were excluded. The key information of patients included as surgery types,sex, operative procedure and status of discharge. Patients underwent valve surgerycombined with CABG, arotic surgery, congenital heart surgery were not excluded andresulted a final study group of11774patients.
2． The patients were divided into3and4groups according to the years ofoperation and institutions, respectively. Patients’ clinical characters were comparedamong groups accordingly.
2. Validation of cardiac valve surgery risk models in our patients set:
1． The patient set were the same as that of part one. The endpoint event wasdefined as hospital death. Cardiac surgery risk models listed blew were selected toevaluate their performance in this patient set: EuroSCOREⅡ, STS2008, SinoSCORE.
2． Value of risk factors for every model was obtained for each patient includedin the study. The predicted operative mortality for each patient was calculated by thelogistic regression formular of risk models.
3． Model discrimination was evaluated by c-index and model calibration wasevaluated by Hosmer-Lemeshow good-of-fit test. Observed/Expected mortality (O/E ratio) was calculated to determine the prediction accuracy of each model.
3. Establishment of risk prediction model and risk score for patients underwentadult heart valve surgery:
1． The patient set were the same as that of part one. Potential risk factors forhospital mortality were selected. The endpoint event of the study was hospitalmortality.
2． Univaries logistic regression was performed for all potential risk factors attheir appropriate coding format to reveal their relationship with hospital mortality.Examination for complete separation and multi-collinearity were also performed.
3． The patients set was splited randomly into development set (70%) andvalidation set (30%), and then the risk model was developed using a logisticregression model with backward selection upon the development set. Risk modelderived from the development set was tested in the validation set.
4． Risk score was established upon the logistic regression model. The list ofpredicted mortality to risk score was calculated. Then, this addictive risk model wasvalidated in both development set and validation set.4. Validation of cardiac valve surgical risk prediction model in patients of eachcardiac surgical center.
1. patient set in this part of research was as the patient set of first part. Hospitaldeath was defined as the endpoint.
2. Validation of Logistic risk model as well as the additive model established inprevious study, STS2008, EuroSCORE Ⅱ and SinoSCORE were perform forpatients of each cardiac center.
【Results】
1. Current situation of Chinese heart valve surgery-a mulitycenter analysis:
1． Comparation of patients’ clinical character between operation years. There isan annual increase in case of valve surgery. There is no significant difference aboutweight and height distribution according to the operative year. Asymptomatic patientsand patients with NYHA class Ⅰ/Ⅱ increased by year. Smoking, hypertension, hyperlipidemia also increased by year in the patients set. Preoperative treatment withdopamine, digitalis, and diuretics also became more popular in recent years.Distribution of surgical procedures was relatively constant except for the annualdecreasment of triscupid repairment. The useage of post-operative adrenaline,norepinephrine and phenylephrine were decreased but the useage of phosphodiesteraswas increase. Percentage of patients who had blood transfusion increased but theaverage amount of blood per patients decreased. The hospital mortality, ventilationtime, time of intensive care unit also decreased by year.
2． Comparation between cardiac surgery centers. Gender composition of fourinstitutions was similar and there are more yong patients in Center A. Average heightand weight of patient were significant lower in Center D than those of other Centers.Proportion of asymptomatic patients was higher in Center A than that of other Centers.Mitral stenosis, mitral insufficiency and aortic insufficiency consiste the majority ofvalve lesions in all the four Centers while the composition of valve lesion differs fromeach other. Hospital mortality was high in Center C and low in Center A while theother two was in the middle position. There are differences between institutions forincidence of other operative complications.
2. Validation of published cardiac valve surgery risk models with our patientsset.
1． Model calibration. There are237death in the whole patients set whichresulted a mortality of2%. Expected mortality by the EuroSCOREⅡ, STS2008,SinoSCORE was2.63%,1.27%,2.83%, respectively. Observed mortality/Expectedmortality (O/E ratio) of EuroSCOREⅡ, STS2008, SinoSCORE was0.77,1.58,0.71,respectively. All three cardiac surgery risk models showed poor performance withpatients set of this study. EuroSCOREⅡ and SinoSCORE overestimated hospitalmortality and STS2008underestimated hospital mortality. With theHosmer-Lemeshow good-of-fit test, EuroSCORE Ⅱ had the best performance amongthree models while the STS2008had the worst performance for the whole patients set.
2． Model discrimination. C-index of EuroSCOREⅡ, STS2008, SinoSCORE was0.715,0.685,0.752, respectively. C-index of EuroSCOREⅡand SinoSCOREexceeds0.7means that EuroSCOREⅡand SinoSCORE had better discriminate powerthan STS2008had.
3． Single valve surgery vs. multiple valve surgery. SinoSCORE showed goodmodel discrimination for either Single valve surgery (C-index0.761) or multiplevalve surgery (C-index0.746). EuroSCOREⅡand STS2008risk models were ofbetter discrimination for single valve surgery (C-index0.739,0.721) than that formultiple valve surgery (C-index0.708,0.660). Hosmer-Lemeshow good-of-fit testdemonstrated that only STS2008risk model for the single valve surgery group havegood calibration (P>0.05).
3. Establishment of risk prediction model for adult heart valve surgery:
1． The final risk prediction model included16risk factors: age (OR:1.21),female (OR:1.38), body surface area (OR:1.78), smoking (OR:1.54), hypertension(OR:1.64), renal failure (OR:6.59), previous heart valve surgery (OR:3.86), leftventricular ejection fraction (OR:1.54), severe pulmonary hypertension (OR:7.27),Severe tricuspid regurgitation (OR:1.98); NYHA class Ⅲ (OR:3.01); NYHA class Ⅳ(OR:7.04), preoperative critical state (OR:4.82), number of conary artery disease(OR:1.56); multiple valve surgery (OR:1.96), combined CABG (OR:7.98).
2． The new developed heart valve surgery risk model showed good calibrationand discriminative power for the development set, validation set and the wholepatients set, with the Hosmer–Lemeshow good-of-fit test’s P value of0.46,0.16and0.63, respectively. C-index of the risk model in development set, validation set and thewhole patients set was0.827,0.763and0.810, respectively. The risk model showgood calibration and discrimination power in the whole study population. Thevalidation study of the risk model in the patient set of each cardiac surgery center alsodemonstrated that the model have excellent prediction ability.
3． Based upon the logistic regression model, an additive model was established.Risk score of the additive model listed blow: age (above65years):0.5score per year;femal:1score; body surface area<1.5m2:1.5score, smoking:1score, hypertension: 1.5score, renal failure:5score, previous heart valve surgery:2score, left ventricularejection fraction<40%:4score, severe pulmonary hypertension:5.5score, severtriscupid insuffiency:2score; NYHA class Ⅲ:3score; NYHA class Ⅳ:5.5score,preoperative critical state:4score, number of conary artery disease:1score per vessel,multiple valve surgery:2score, combined CABG:6score. For bedside useage,corresponding predicted mortality to the full range of risk score was also calculated.The additive model’s prediction accuracy was confirmed by validation on the wholepatients set, with O/E ratio of1.11, C-index of0.808and Hosmer–Lemeshowgood-of-fit test’s P value of0.28. The validation of this addictive model for thedevelopment set, validation set and every cardiac surgery center demonstrated thatthe additive model have excellent prediction ability.
4. Validation of cardiac valve surgical risk prediction model in patients of eachcardiac surgical center.
1. Both the logistic risk model and additive risk model have excellent predictionpower for patients of each cardiac surgical center.
2. The new established valve surgical risk model was more suitable forestimating operative mortality after valve surgery than STS2008,EuroSCOREⅡand SinoSCORE.
【Conclusion】
1. This project analyses the clinical character of patients who underwent heartvalve surgery in four cardiac surgery centers from Jan.1st,2006to Dec.31,2008retrospectively. Then the annual changes and hospital level difference of patients’clinical character were identified.
2. EuroSCOREⅡ, STS2008, SinoSCORE were validated by the patients setfrom four Chinese cardiac surgical center. These three cardiac risk models weredemonstrated of poor calibration and reasonable discrimination. STS2008risk modelwas the only risk model suitable for single valve surgery with good calibration andreasonable discrimination.
3. A new adult cardiac risk prediction model and corresponding addictive risk model was developed based on our patients set. This risk model was developed for alladult cardiac valve surgery in China. The inner validation of this risk model showedexcellent performance.
4. Validation study of the new established risk prediction model was performedfor patients of each cardiac center. The risk predition model showed high accuracy inestimating the operative mortialy, and it is better than the STS2008, EuroSCOREⅡand SinoSCORE.
引文
[1] Bonow RO, Carabello BA, Chatterjee K, et al.2008focused update incorporatedinto the ACC/AHA2006guidelines for the management of patients with valvularheart disease: a report of the American College of Cardiology/American HeartAssociation Task Force on Practice Guidelines (Writing Committee to revise the1998guidelines for the management of patients with valvular heart disease).Endorsed by the Society of Cardiovascular Anesthesiologists, Society forCardiovascular Angiography and Interventions, and Society of ThoracicSurgeons.[J].J Am Coll Cardiol2008;52(13):e1-142.
[2] Kamath AR, Varadarajan P, Turk R, et al. Survival in patients with severe aorticregurgitation and severe left ventricular dysfunction is improved by aortic valvereplacement: results from a cohort of166patients with an ejection fraction [3] Levy F, Laurent M, Monin JL, et al. Aortic valve replacement forlow-flow/low-gradient aortic stenosis operative risk stratification and long-termoutcome: a European multicenter study.[J].J Am Coll Cardiol2008;51(15):1466-1472.
[4] Bonow RO, Dodd JT, Maron BJ, et al. Long-term serial changes in leftventricular function and reversal of ventricular dilatation after valve replacementfor chronic aortic regurgitation.[J].Circulation1988;78(5Pt1):1108-1120.
[5] Bonow RO, Picone AL, McIntosh CL, et al. Survival and functional results aftervalve replacement for aortic regurgitation from1976to1983: impact ofpreoperative left ventricular function.[J].Circulation1985;72(6):1244-1256.
[6] Yurdakul S, Tayyareci Y, Yildirimturk O, Memic K, Aytekin V, Aytekin S.Subclinical left ventricular dysfunction in asymptomatic chronic mitralregurgitation patients with normal ejection fraction: a combined tissue Dopplerand velocity vector imaging-based study.[J].Echocardiography2011;28(8):877-885
[7] Ozdogan O, Yuksel A, Gurgun C, Kayikcioglu M, Yavuzgil O, Cinar CS.Assessment of cardiac remodeling in asymptomatic mitral regurgitation forsurgery timing: a comparative study of echocardiography and magnetic resonanceimaging.[J].Cardiovasc Ultrasound2010;8:32.
[8] Owen A, Henein MY. Challenges in the management of severe asymptomaticaortic stenosis.[J].Eur J Cardiothorac Surg2011;40(4):848-850.
[9] Montant P, Chenot F, Robert A, et al. Long-term survival in asymptomaticpatients with severe degenerative mitral regurgitation: a propensity score-basedcomparison between an early surgical strategy and a conservative treatmentapproach.[J].J Thorac Cardiovasc Surg2009;138(6):1339-1348.
[10]Gillinov AM, Mihaljevic T, Blackstone EH, et al. Should patients with severedegenerative mitral regurgitation delay surgery until symptoms develop?[J].AnnThorac Surg2010;90(2):481-488.
[11]Chenot F, Montant P, Vancraeynest D, et al. Long-term clinical outcome of mitralvalve repair in asymptomatic severe mitral regurgitation.[J].Eur J CardiothoracSurg2009;36(3):539-545.
[12]Herlitz J, Brandrup-Wognsen G, Caidahl K, et al. Mortality and morbidity amongpatients who undergo combined valve and coronary artery bypass surgery: Earlyand late results.[J].European Journal of Cardio-Thoracic Surgery1997;12(6):836-846.
[13]O'Brien SM, Shahian DM, Filardo G, et al. The Society of Thoracic Surgeons2008cardiac surgery risk models: part2--isolated valve surgery.[J].Ann ThoracSurg2009;88(1Suppl):S23-42.
[14]Hudetz JA, Iqbal Z, Gandhi SD, Patterson KM, Byrne AJ, Pagel PS.Postoperative Delirium and Short-term Cognitive Dysfunction Occur MoreFrequently in Patients Undergoing Valve Surgery With or Without CoronaryArtery Bypass Graft Surgery Compared With Coronary Artery Bypass GraftSurgery Alone: Results of a Pilot Study.[J].Journal of Cardiothoracic and VascularAnesthesia2011;25(5):811-816.
[15]Thourani VH, Weintraub WS, Craver JM, et al. Influence of concomitant CABGand urgent/emergent status on mitral valve replacement surgery.[J].The Annals ofThoracic Surgery2000;70(3):778-783.
[16]Amirak E, Chan KM, Zakkar M, Punjabi PP. Current status of surgery fordegenerative mitral valve disease.[J].Prog Cardiovasc Dis2009;51(6):454-459.
[17]Ahmed MI, McGiffin DC, O'Rourke RA, Dell'Italia LJ. Mitralregurgitation.[J].Curr Probl Cardiol2009;34(3):93-136.
[18]Zigelman CZ, Edelstein PM. Aortic valve stenosis.[J].Anesthesiol Clin2009;27(3):519-532, table of contents.
[19]Spann JF, Jr., Sands MJ, Jr. The incidence and significance of atrial dysrhythmiasin rheumatic valvular disease.[J].Cardiovasc Clin1973;5(2):115-129.
[20]Kabukcu M, Arslantas E, Ates I, Demircioglu F, Ersel F. Clinical,echocardiographic, and hemodynamic characteristics of rheumatic mitral valvestenosis and atrial fibrillation.[J].Angiology2005;56(2):159-163.
[21]Kuwaki K, Kawaharada N, Morishita K, et al. Mitral valve repair versusreplacement in simultaneous mitral and aortic valve surgery for rheumaticdisease.[J].Ann Thorac Surg2007;83(2):558-563.
[22]Michelena HI, Topilsky Y, Suri R, Enriquez-Sarano M. Degenerative mitral valveregurgitation: understanding basic concepts and new developments.[J].PostgradMed2011;123(2):56-69.
[23]Foster E. Clinical practice. Mitral regurgitation due to degenerative mitral-valvedisease.[J].N Engl J Med2010;363(2):156-165.
[24]Faber L, Lamp B. Mitral valve regurgitation and left ventricular systolicdysfunction: corrective surgery or cardiac resynchronizationtherapy?[J].Herzschrittmacherther Elektrophysiol2008;19Suppl1:52-59.
[25]Anderson CA, Chitwood WR. Advances in mitral valve repair.[J].Future Cardiol2009;5(5):511-516.
[26]Augoustides JG, Atluri P. Progress in mitral valve disease: understanding therevolution.[J].J Cardiothorac Vasc Anesth2009;23(6):916-923.
[27]Rosenhek R, Maurer G. Management of valvular mitral regurgitation: theimportance of risk stratification.[J].J Cardiol2010;56(3):255-261.
[28]Pomerantzeff PM, Brandao CM, Leite Filho OA, et al. Mitral valve repair inrheumatic patients with mitral insuficiency: twenty years of techniques andresults.[J].Rev Bras Cir Cardiovasc2009;24(4):485-489.
[29]Kim JB, Kim HJ, Moon DH, et al. Long-term outcomes after surgery forrheumatic mitral valve disease: valve repair versus mechanical valvereplacement.[J].Eur J Cardiothorac Surg2010;37(5):1039-1046.
[30]Antunes MJ. Valve repair for rheumatic mitral regurgitation: still worthwhile?[J].JHeart Valve Dis2011;20(3):254-256.
[31]Kuduvalli M, Grayson AD, Au J, Grotte G, Bridgewater B, Fabri BM. Amulti-centre additive and logistic risk model for in-hospital mortality followingaortic valve replacement.[J].Eur J Cardiothorac Surg2007;31(4):607-613.
[32]Thomas M. The global experience with percutaneous aortic valvereplacement.[J].JACC Cardiovasc Interv2010;3(11):1103-1109.
[33]Mookadam F, Jalal U, Wilansky S. Aortic valve disease: preventable orinevitable?[J].Future Cardiol2010;6(6):777-783.
[34]Nissinen J, Biancari F, Wistbacka JO, et al. Safe time limits of aorticcross-clamping and cardiopulmonary bypass in adult cardiac surgery.[J].Perfusion2009;24(5):297-305.
[35]Bar-El Y, Adler Z, Kophit A, et al. Myocardial protection in operations requiringmore than2h of aortic cross-clamping.[J].Eur J Cardiothorac Surg1999;15(3):271-275.
[36]Higami T, Yamamoto S, Ogawa K, et al.[Myocardial protection with retrogradecold blood cardioplegia in prolonged aortic cross-clamping].[J].Rinsho KyobuGeka1988;8(4):374-379.
[37]Tanaka H, Yoshida T, Nakagawa T, et al.[Study of cases with prolonged aorticcross-clamping times (>240min) using cold K(+)-Mg++cardioplegia].[J].Rinsho Kyobu Geka1988;8(3):270-274.
[38]Berglin E, Feddersen K, Gatzinsky P, Rohsman B, Wallentin I, William-Olsson G.Aortic cross-clamping for more than2hours in open-heart surgery. Early resultsin87patients.[J].Thorac Cardiovasc Surg1983;31(5):273-276.
[1] Nashef SA, Roques F, Sharples LD, et al. EuroSCORE II. Eur J CardiothoracSurg2012Apr;41(4):734-45.
[2] O'Brien SM, Shahian DM, Filardo G, et al. The Society of Thoracic Surgeons2008cardiac surgery risk models: part2--isolated valve surgery. Ann ThoracSurg2009Jul;88(1Suppl):S23-42.
[3] Shahian DM, O'Brien SM, Filardo G, et al. The Society of Thoracic Surgeons2008cardiac surgery risk models: part3--valve plus coronary artery bypassgrafting surgery. Ann Thorac Surg2009Jul;88(1Suppl):S43-62.
[4] Shahian DM, O'Brien SM, Filardo G, et al. The Society of Thoracic Surgeons2008cardiac surgery risk models: part1--coronary artery bypass grafting surgery.Ann Thorac Surg2009Jul;88(1Suppl):S2-22.
[5]郑哲,张路,胡盛寿.中国冠状动脉旁路移植手术风险评估.中华心血管病杂志2010;38(10).
[6] Grant SW, Hickey GL, Dimarakis I, et al. How does EuroSCORE II perform inUK cardiac surgery; an analysis of23740patients from the Society forCardiothoracic Surgery in Great Britain and Ireland National Database. Heart2012Sep7.
[7] Di Dedda U, Pelissero G, Agnelli B, De Vincentiis C, Castelvecchio S, RanucciM. Accuracy, calibration and clinical performance of the new EuroSCORE IIrisk stratification system. Eur J Cardiothorac Surg2012Jul20.
[8] Biancari F, Vasques F, Mikkola R, Martin M, Lahtinen J, Heikkinen J. Validationof EuroSCORE II in patients undergoing coronary artery bypass surgery. AnnThorac Surg2012Jun;93(6):1930-5.
[9]中国心血管外科注册登记研究协作组. SinoSCORE对手术风险的评估作用.中华胸心血管外科杂志2011;27(2).
[10]中国心血管外科注册登记研究协作组. SinoSCORE对老年心血管外科病人的手术风险预测作用.中华胸心血管外科杂志2011;27(2).
[11]中国心血管外科注册登记研究协作组.非体外循环冠状动脉旁路移植术后早期死亡风险预测——SinoSCORE与EuroSCORE评分的对比.中华胸心血管外科杂志2011;27(2).
[12]中国心血管外科注册登记研究协作组. SinoSCORE预测瓣膜手术死亡风险.中华胸心血管外科杂志2011;27(2).
[13]苏丕雄,刘岩,顾松,颜钧,张希涛,赵洋. SinoSCORE对CABG术后死亡和并发症的预测价值.中华胸心血管外科杂志2011;27(2).
[14]郭惠明,吴若彬,肖学钧, et al. SinoSCORE预测心血管外科手术病死率——广东心血管病研究所经验.中华胸心血管外科杂志2011;27(2).
[15] Chalmers J, Pullan M, Fabri B, et al. Validation of EuroSCORE II in a moderncohort of patients undergoing cardiac surgery. Eur J Cardiothorac Surg2012Jul24.
[16] Basraon J, Chandrashekhar YS, John R, et al. Comparison of risk scores toestimate perioperative mortality in aortic valve replacement surgery. Ann ThoracSurg2011Aug;92(2):535-40.
[1] NASHEF S A, ROQUES F, SHARPLES L D, et al. EuroSCORE II [J]. Eur JCardiothorac Surg,2012,41(4):734-45.
[2] ROQUES F, MICHEL P, GOLDSTONE A R, et al. The logistic EuroSCORE [J].Eur Heart J,2003,24(9):881-2.
[3] NASHEF S A, ROQUES F, MICHEL P, et al. European system for cardiacoperative risk evaluation (EuroSCORE)[J]. Eur J Cardiothorac Surg,1999,16(1):9-13.
[4] WANG C, YAO F, HAN L, et al. Validation of the European system for cardiacoperative risk evaluation (EuroSCORE) in Chinese heart valve surgery patients[J]. J Heart Valve Dis,2010,19(1):21-7.
[5] SHAHIAN D M, O'BRIEN S M, FILARDO G, et al. The Society of ThoracicSurgeons2008cardiac surgery risk models: part1--coronary artery bypassgrafting surgery [J]. Ann Thorac Surg,2009,88(1Suppl): S2-22.
[6] SHAHIAN D M, O'BRIEN S M, FILARDO G, et al. The Society of ThoracicSurgeons2008cardiac surgery risk models: part3--valve plus coronary arterybypass grafting surgery [J]. Ann Thorac Surg,2009,88(1Suppl): S43-62.
[7] O'BRIEN S M, SHAHIAN D M, FILARDO G, et al. The Society of ThoracicSurgeons2008cardiac surgery risk models: part2--isolated valve surgery [J].Ann Thorac Surg,2009,88(1Suppl): S23-42.
[8] HANNAN E L, FARRELL L S, WECHSLER A, et al. The new york risk scorefor in-hospital and30-day mortality for coronary artery bypass graft surgery [J].Ann Thorac Surg,2013,95(1):46-52.
[9] HANNAN E L, WU C, BENNETT E V, et al. Risk index for predictingin-hospital mortality for cardiac valve surgery [J]. Ann Thorac Surg,2007,83(3):921-9.
[10] HANNAN E L, KILBURN H, JR., RACZ M, et al. Improving the outcomes ofcoronary artery bypass surgery in New York State [J]. JAMA,1994,271(10):761-6.
[11] O'CONNOR G T, PLUME S K, OLMSTEAD E M, et al. Multivariate predictionof in-hospital mortality associated with coronary artery bypass graft surgery.Northern New England Cardiovascular Disease Study Group [J]. Circulation,1992,85(6):2110-8.
[12] EDWARDS F H, CLARK R E, SCHWARTZ M. Coronary artery bypass grafting:the Society of Thoracic Surgeons National Database experience [J]. Ann ThoracSurg,1994,57(1):12-9.
[13] RANUCCI M, CASTELVECCHIO S, MENICANTI L, et al. Risk of assessingmortality risk in elective cardiac operations: age, creatinine, ejection fraction,and the law of parsimony [J]. Circulation,2009,119(24):3053-61.
[1] O'BRIEN S M, SHAHIAN D M, FILARDO G, et al. The Society of ThoracicSurgeons2008cardiac surgery risk models: part2--isolated valve surgery [J]. AnnThorac Surg,2009,88(1Suppl): S23-42.
[2] SHAHIAN D M, O'BRIEN S M, FILARDO G, et al. The Society of ThoracicSurgeons2008cardiac surgery risk models: part3--valve plus coronary arterybypass grafting surgery [J]. Ann Thorac Surg,2009,88(1Suppl): S43-62.
[3] SHAHIAN D M, O'BRIEN S M, FILARDO G, et al. The Society of ThoracicSurgeons2008cardiac surgery risk models: part1--coronary artery bypassgrafting surgery [J]. Ann Thorac Surg,2009,88(1Suppl): S2-22.
[4]郑哲,张路,胡盛寿.中国冠状动脉旁路移植手术风险评估[J].中华心血管病杂志,2010,38(10):
[5] NASHEF S A, ROQUES F, SHARPLES L D, et al. EuroSCORE II [J]. Eur JCardiothorac Surg,2012,41(4):734-45.
[6] GRANT S W, HICKEY G L, DIMARAKIS I, et al. How does EuroSCORE IIperform in UK cardiac surgery; an analysis of23740patients from the Societyfor Cardiothoracic Surgery in Great Britain and Ireland National Database [J].Heart,2012,
[7] DI DEDDA U, PELISSERO G, AGNELLI B, et al. Accuracy, calibration andclinical performance of the new EuroSCORE II risk stratification system [J]. EurJ Cardiothorac Surg,2012,
[8] NOYEZ L, KIEVIT P C, VAN SWIETEN H A, et al. Cardiac operative riskevaluation: The EuroSCORE II, does it make a real difference?[J]. Neth Heart J,2012,
[9]中国心血管外科注册登记研究协作组. SinoSCORE预测瓣膜手术死亡风险[J].中华胸心血管外科杂志,2011,27(2):
[10]中国心血管外科注册登记研究协作组. SinoSCORE对老年心血管外科病人的手术风险预测作用[J].中华胸心血管外科杂志,2011,27(2):
[1] DALEY J. Criteria by which to evaluate risk-adjusted outcomes programs in cardiac surgery[J]. The Annals of Thoracic Surgery,1994,58(6):1827-35.
[2] IEZZONI L I. The risks of risk adjustment [J]. JAMA,1997,278(19):1600-7.
[3] TU J V, SYKORA K, NAYLOR C D. Assessing the outcomes of coronary artery bypass graftsurgery: how many risk factors are enough? Steering Committee of the Cardiac CareNetwork of Ontario [J]. J Am Coll Cardiol,1997,30(5):1317-23.
[4] LUFT H S, ROMANO P S. Chance, continuity, and change in hospital mortality rates.Coronary artery bypass graft patients in California hospitals,1983to1989[J]. JAMA,1993,270(3):331-7.
[5] GRUNKEMEIER G L, PAYNE N, JIN R, et al. Propensity score analysis of stroke afteroff-pump coronary artery bypass grafting [J]. Ann Thorac Surg,2002,74(2):301-5.
[6] BLACKSTONE E H. Comparing apples and oranges [J]. J Thorac Cardiovasc Surg,2002,123(1):8-15.
[7] EDWARDS F H, ALBUS R A, ZAJTCHUK R, et al. Use of a Bayesian statistical model forrisk assessment in coronary artery surgery [J]. Ann Thorac Surg,1988,45(4):437-40.
[8] PARSONNET V, DEAN D, BERNSTEIN A D. A method of uniform stratification of risk forevaluating the results of surgery in acquired adult heart disease [J]. Circulation,1989,79(6Pt2): I3-12.
[9] HIGGINS T L, ESTAFANOUS F G, LOOP F D, et al. Stratification of morbidity andmortality outcome by preoperative risk factors in coronary artery bypass patients. A clinicalseverity score [J]. JAMA,1992,267(17):2344-8.
[10] O'CONNOR G T, PLUME S K, OLMSTEAD E M, et al. Multivariate prediction ofin-hospital mortality associated with coronary artery bypass graft surgery. Northern NewEngland Cardiovascular Disease Study Group [J]. Circulation,1992,85(6):2110-8.
[11] EAGLE K A, GUYTON R A, DAVIDOFF R, et al. ACC/AHA guidelines for coronary arterybypass graft surgery: executive summary and recommendations: A report of the AmericanCollege of Cardiology/American Heart Association Task Force on Practice Guidelines(Committee to revise the1991guidelines for coronary artery bypass graft surgery)[J].Circulation,1999,100(13):1464-80.
[12] NOWICKI E R, BIRKMEYER N J, WEINTRAUB R W, et al. Multivariable prediction ofin-hospital mortality associated with aortic and mitral valve surgery in Northern NewEngland [J]. Ann Thorac Surg,2004,77(6):1966-77.
[13] HANNAN E L, KILBURN H, JR., RACZ M, et al. Improving the outcomes of coronaryartery bypass surgery in New York State [J]. JAMA,1994,271(10):761-6.
[14] HANNAN E L, WU C, BENNETT E V, et al. Risk index for predicting in-hospital mortalityfor cardiac valve surgery [J]. Ann Thorac Surg,2007,83(3):921-9.
[15] WU C, CAMACHO F T, WECHSLER A S, et al. Risk score for predicting long-termmortality after coronary artery bypass graft surgery [J]. Circulation,2012,125(20):2423-30.
[16] HANNAN E L, FARRELL L S, WECHSLER A, et al. The new york risk score forin-hospital and30-day mortality for coronary artery bypass graft surgery [J]. Ann ThoracSurg,2013,95(1):46-52.
[17] EDWARDS F H, CLARK R E, SCHWARTZ M. Coronary artery bypass grafting: theSociety of Thoracic Surgeons National Database experience [J]. Ann Thorac Surg,1994,57(1):12-9.
[18] EDWARDS F H, GROVER F L, SHROYER A L, et al. The Society of Thoracic SurgeonsNational Cardiac Surgery Database: current risk assessment [J]. Ann Thorac Surg,1997,63(3):903-8.
[19] SHROYER A L, GROVER F L, EDWARDS F H.1995coronary artery bypass risk model:The Society of Thoracic Surgeons Adult Cardiac National Database [J]. Ann Thorac Surg,1998,65(3):879-84.
[20] LIPPMANN R P, SHAHIAN D M. Coronary artery bypass risk prediction using neuralnetworks [J]. Ann Thorac Surg,1997,63(6):1635-43.
[21] SHROYER A L, COOMBS L P, PETERSON E D, et al. The Society of Thoracic Surgeons:30-day operative mortality and morbidity risk models [J]. Ann Thorac Surg,2003,75(6):1856-64; discussion64-5.
[22] RANKIN J S, HAMMILL B G, FERGUSON T B, JR., et al. Determinants of operativemortality in valvular heart surgery [J]. J Thorac Cardiovasc Surg,2006,131(3):547-57.
[23] SHAHIAN D M, O'BRIEN S M, FILARDO G, et al. The Society of Thoracic Surgeons2008cardiac surgery risk models: part1--coronary artery bypass grafting surgery [J]. Ann ThoracSurg,2009,88(1Suppl): S2-22.
[24] SHAHIAN D M, O'BRIEN S M, FILARDO G, et al. The Society of Thoracic Surgeons2008cardiac surgery risk models: part3--valve plus coronary artery bypass grafting surgery [J].Ann Thorac Surg,2009,88(1Suppl): S43-62.
[25] O'BRIEN S M, SHAHIAN D M, FILARDO G, et al. The Society of Thoracic Surgeons2008cardiac surgery risk models: part2--isolated valve surgery [J]. Ann Thorac Surg,2009,88(1Suppl): S23-42.
[26] SHAHIAN D M, EDWARDS F H. The Society of Thoracic Surgeons2008cardiac surgeryrisk models: introduction [J]. Ann Thorac Surg,2009,88(1Suppl): S1.
[27] SHAHIAN D M, O'BRIEN S M, SHENG S, et al. Predictors of Long-Term Survival AfterCoronary Artery Bypass Grafting Surgery: Results From the Society of Thoracic SurgeonsAdult Cardiac Surgery Database (The ASCERT Study)[J]. Circulation,2012,125(12):1491-500.
[28] TU J V, JAGLAL S B, NAYLOR C D. Multicenter validation of a risk index for mortality,intensive care unit stay, and overall hospital length of stay after cardiac surgery. SteeringCommittee of the Provincial Adult Cardiac Care Network of Ontario [J]. Circulation,1995,91(3):677-84.
[29] IVANOV J, TU J V, NAYLOR C D. Ready-made, recalibrated, or Remodeled? Issues in theuse of risk indexes for assessing mortality after coronary artery bypass graft surgery [J].Circulation,1999,99(16):2098-104.
[30] KURKI T S, KATAJA M. Preoperative prediction of postoperative morbidity in coronaryartery bypass grafting [J]. Ann Thorac Surg,1996,61(6):1740-5.
[31] MAGOVERN J A, SAKERT T, MAGOVERN G J, et al. A model that predicts morbidity andmortality after coronary artery bypass graft surgery [J]. J Am Coll Cardiol,1996,28(5):1147-53.
[32] PONS J M, GRANADOS A, ESPINAS J A, et al. Assessing open heart surgery mortality inCatalonia (Spain) through a predictive risk model [J]. Eur J Cardiothorac Surg,1997,11(3):415-23.
[33] BRIDGEWATER B, NEVE H, MOAT N, et al. Predicting operative risk for coronary arterysurgery in the United Kingdom: a comparison of various risk prediction algorithms [J]. Heart,1998,79(4):350-5.
[34] MOZES B, OLMER L, GALAI N, et al. A national study of postoperative mortalityassociated with coronary artery bypass grafting in Israel. ISCAB Consortium. IsraelCoronary Artery Bypass Study [J]. Ann Thorac Surg,1998,66(4):1254-62; discussion63.
[35] WONG D T, CHENG D C, KUSTRA R, et al. Risk factors of delayed extubation, prolongedlength of stay in the intensive care unit, and mortality in patients undergoing coronary arterybypass graft with fast-track cardiac anesthesia: a new cardiac risk score [J]. Anesthesiology,1999,91(4):936-44.
[36] NASHEF S A, ROQUES F, MICHEL P, et al. European system for cardiac operative riskevaluation (EuroSCORE)[J]. Eur J Cardiothorac Surg,1999,16(1):9-13.
[37] ROQUES F, NASHEF S A, MICHEL P, et al. Risk factors and outcome in European cardiacsurgery: analysis of the EuroSCORE multinational database of19030patients [J]. Eur JCardiothorac Surg,1999,15(6):816-22; discussion22-3.
[38] ROQUES F, MICHEL P, GOLDSTONE A R, et al. The logistic EuroSCORE [J]. Eur Heart J,2003,24(9):881-2.
[39] NASHEF S A, ROQUES F, SHARPLES L D, et al. EuroSCORE II [J]. Eur J CardiothoracSurg,2012,41(4):734-45.
[40] BERNSTEIN A D, PARSONNET V. Bedside estimation of risk as an aid fordecision-making in cardiac surgery [J]. Ann Thorac Surg,2000,69(3):823-8.
[41] ZAROFF J G, DITOMMASO D G, BARRON H V. A risk model derived from the NationalRegistry of Myocardial Infarction2database for predicting mortality after coronary arterybypass grafting during acute myocardial infarction [J]. Am J Cardiol,2002,90(1):1-4.
[42] HUIJSKES R V, ROSSEEL P M, TIJSSEN J G. Outcome prediction in coronary arterybypass grafting and valve surgery in the Netherlands: development of the Amphiascore andits comparison with the Euroscore [J]. Eur J Cardiothorac Surg,2003,24(5):741-9.
[43] CHAUDHURI N, JAMES J, SHEIKH A, et al. Intestinal ischaemia following cardiacsurgery: a multivariate risk model [J]. Eur J Cardiothorac Surg,2006,29(6):971-7.
[44] MOTOMURA N, MIYATA H, TSUKIHARA H, et al. First report on30-day and operativemortality in risk model of isolated coronary artery bypass grafting in Japan [J]. Ann ThoracSurg,2008,86(6):1866-72.
[45] MOTOMURA N, MIYATA H, TSUKIHARA H, et al. Risk model of thoracic aortic surgeryin4707cases from a nationwide single-race population through a web-based data entrysystem: the first report of30-day and30-day operative outcome risk models for thoracicaortic surgery [J]. Circulation,2008,118(14Suppl): S153-9.
[46] MOTOMURA N, MIYATA H, TSUKIHARA H, et al. Risk model of valve surgery in Japanusing the Japan Adult Cardiovascular Surgery Database [J]. J Heart Valve Dis,2010,19(6):684-91.
[47] MIYATA H, MOTOMURA N, TSUKIHARA H, et al. Risk models including high-riskcardiovascular procedures: clinical predictors of mortality and morbidity [J]. Eur JCardiothorac Surg,2011,39(5):667-74.
[48] MIYATA H, MOTOMURA N, YOZU R, et al. Cardiovascular surgery risk prediction fromthe patient's perspective [J]. J Thorac Cardiovasc Surg,2011,142(3): e71-6.
[49] TOUMPOULIS I K, CHAMOGEORGAKIS T P, ANGOURAS D C, et al. Independentpredictors for early and long-term mortality after heart valve surgery [J]. J Heart Valve Dis,2008,17(5):548-56.
[50] CAROSELLA V C, NAVIA J L, AL-RUZZEH S, et al. The first Latin-American riskstratification system for cardiac surgery: can be used as a graphic pocket-card score [J].Interact Cardiovasc Thorac Surg,2009,9(2):203-8.
[51] CISLAGHI F, CONDEMI A M, CORONA A. Predictors of prolonged mechanical ventilationin a cohort of5123cardiac surgical patients [J]. Eur J Anaesthesiol,2009,26(5):396-403.
[52] HERMAN C, KAROLAK W, YIP A M, et al. Predicting prolonged intensive care unit lengthof stay in patients undergoing coronary artery bypass surgery--development of an entirelypreoperative scorecard [J]. Interact Cardiovasc Thorac Surg,2009,9(4):654-8.
[53] REID C, BILLAH B, DINH D, et al. An Australian risk prediction model for30-daymortality after isolated coronary artery bypass: the AusSCORE [J]. J Thorac Cardiovasc Surg,2009,138(4):904-10.
[54] BILLAH B, REID C M, SHARDEY G C, et al. A preoperative risk prediction model for30-day mortality following cardiac surgery in an Australian cohort [J]. Eur J CardiothoracSurg,2010,37(5):1086-92.
[55] RANUCCI M, CASTELVECCHIO S, MENICANTI L A, et al. An adjusted EuroSCOREmodel for high-risk cardiac patients [J]. Eur J Cardiothorac Surg,2009,36(5):791-7.
[56] RANUCCI M, CASTELVECCHIO S, MENICANTI L, et al. Risk of assessing mortality riskin elective cardiac operations: age, creatinine, ejection fraction, and the law of parsimony [J].Circulation,2009,119(24):3053-61.
[57] CADORE M P, GUARAGNA J C, ANACKER J F, et al. A score proposal to evaluatesurgical risk in patients submitted to myocardial revascularization surgery [J]. Rev Bras CirCardiovasc,2010,25(4):447-56.
[58] MAGEDANZ E H, BODANESE L C, GUARAGNA J C, et al. Risk score elaboration formediastinitis after coronary artery bypass grafting [J]. Rev Bras Cir Cardiovasc,2010,25(2):154-9.
[59] MICELI A, DUGGAN S M, CAPOUN R, et al. A clinical score to predict the need forintraaortic balloon pump in patients undergoing coronary artery bypass grafting [J]. AnnThorac Surg,2010,90(2):522-6.
[60] GUO L X, MENG X, ZHANG Z G, et al. Analysis of risk factors for valve replacements in5,128cases from a single heart center in China [J]. Chin Med J (Engl),2010,123(24):3509-14.
[61]郑哲,张路,胡盛寿.中国冠状动脉旁路移植手术风险评估[J].中华心血管病杂志,2010,38(10):
[62] AMBROSETTI M, TRAMARIN R, GRIFFO R, et al. Late postoperative atrial fibrillationafter cardiac surgery: a national survey within the cardiac rehabilitation setting [J]. JCardiovasc Med (Hagerstown),2011,12(6):390-5.
[63] RAHMANIAN P B, KWIECIEN G, LANGEBARTELS G, et al. Logistic risk modelpredicting postoperative renal failure requiring dialysis in cardiac surgery patients [J]. Eur JCardiothorac Surg,2011,40(3):701-7.
[64] SINGH T P, ALMOND C S, SEMIGRAN M J, et al. Risk prediction for early in-hospitalmortality following heart transplantation in the United States [J]. Circ Heart Fail,2012,5(2):259-66.
[65] WEISS E S, ALLEN J G, KILIC A, et al. Development of a quantitative donor risk index topredict short-term mortality in orthotopic heart transplantation [J]. J Heart Lung Transplant,2012,31(3):266-73.
[66] TANAKA S, SAKATA R, MARUI A, et al. Predicting long-term mortality after firstcoronary revascularization:-the Kyoto model [J]. Circ J,2012,76(2):328-34.
[67] O'CONNOR G T, PLUME S K, OLMSTEAD E M, et al. A regional prospective study ofin-hospital mortality associated with coronary artery bypass grafting. The Northern NewEngland Cardiovascular Disease Study Group [J]. JAMA,1991,266(6):803-9.
[68] GRIFFITH B P, HATTLER B G, HARDESTY R L, et al. The need for accurate risk-adjustedmeasures of outcome in surgery. Lessons learned through coronary artery bypass [J]. AnnSurg,1995,222(4):593-8; discussion8-9.
[69] NILSSON J, OHLSSON M, THULIN L, et al. Risk factor identification and mortalityprediction in cardiac surgery using artificial neural networks [J]. J Thorac Cardiovasc Surg,2006,132(1):12-9.
[70] HARRELL F E, JR., LEE K L, MARK D B. Multivariable prognostic models: issues indeveloping models, evaluating assumptions and adequacy, and measuring and reducingerrors [J]. Stat Med,1996,15(4):361-87.
[71] NASHEF S A, ROQUES F, HAMMILL B G, et al. Validation of European System forCardiac Operative Risk Evaluation (EuroSCORE) in North American cardiac surgery [J]. EurJ Cardiothorac Surg,2002,22(1):101-5.
[72] GRUNKEMEIER G L, ZERR K J, JIN R. Cardiac surgery report cards: making the grade [J].Ann Thorac Surg,2001,72(6):1845-8.
[2] Kamath AR, Varadarajan P, Turk R, et al. Survival in patients with severe aorticregurgitation and severe left ventricular dysfunction is improved by aortic valvereplacement: results from a cohort of166patients with an ejection fraction
[4] Bonow RO, Dodd JT, Maron BJ, et al. Long-term serial changes in leftventricular function and reversal of ventricular dilatation after valve replacementfor chronic aortic regurgitation.[J].Circulation1988;78(5Pt1):1108-1120.
[5] Bonow RO, Picone AL, McIntosh CL, et al. Survival and functional results aftervalve replacement for aortic regurgitation from1976to1983: impact ofpreoperative left ventricular function.[J].Circulation1985;72(6):1244-1256.
[6] Yurdakul S, Tayyareci Y, Yildirimturk O, Memic K, Aytekin V, Aytekin S.Subclinical left ventricular dysfunction in asymptomatic chronic mitralregurgitation patients with normal ejection fraction: a combined tissue Dopplerand velocity vector imaging-based study.[J].Echocardiography2011;28(8):877-885
[7] Ozdogan O, Yuksel A, Gurgun C, Kayikcioglu M, Yavuzgil O, Cinar CS.Assessment of cardiac remodeling in asymptomatic mitral regurgitation forsurgery timing: a comparative study of echocardiography and magnetic resonanceimaging.[J].Cardiovasc Ultrasound2010;8:32.
[8] Owen A, Henein MY. Challenges in the management of severe asymptomaticaortic stenosis.[J].Eur J Cardiothorac Surg2011;40(4):848-850.
[9] Montant P, Chenot F, Robert A, et al. Long-term survival in asymptomaticpatients with severe degenerative mitral regurgitation: a propensity score-basedcomparison between an early surgical strategy and a conservative treatmentapproach.[J].J Thorac Cardiovasc Surg2009;138(6):1339-1348.
[10]Gillinov AM, Mihaljevic T, Blackstone EH, et al. Should patients with severedegenerative mitral regurgitation delay surgery until symptoms develop?[J].AnnThorac Surg2010;90(2):481-488.
[11]Chenot F, Montant P, Vancraeynest D, et al. Long-term clinical outcome of mitralvalve repair in asymptomatic severe mitral regurgitation.[J].Eur J CardiothoracSurg2009;36(3):539-545.
[12]Herlitz J, Brandrup-Wognsen G, Caidahl K, et al. Mortality and morbidity amongpatients who undergo combined valve and coronary artery bypass surgery: Earlyand late results.[J].European Journal of Cardio-Thoracic Surgery1997;12(6):836-846.
[13]O'Brien SM, Shahian DM, Filardo G, et al. The Society of Thoracic Surgeons2008cardiac surgery risk models: part2--isolated valve surgery.[J].Ann ThoracSurg2009;88(1Suppl):S23-42.
[14]Hudetz JA, Iqbal Z, Gandhi SD, Patterson KM, Byrne AJ, Pagel PS.Postoperative Delirium and Short-term Cognitive Dysfunction Occur MoreFrequently in Patients Undergoing Valve Surgery With or Without CoronaryArtery Bypass Graft Surgery Compared With Coronary Artery Bypass GraftSurgery Alone: Results of a Pilot Study.[J].Journal of Cardiothoracic and VascularAnesthesia2011;25(5):811-816.
[15]Thourani VH, Weintraub WS, Craver JM, et al. Influence of concomitant CABGand urgent/emergent status on mitral valve replacement surgery.[J].The Annals ofThoracic Surgery2000;70(3):778-783.
[16]Amirak E, Chan KM, Zakkar M, Punjabi PP. Current status of surgery fordegenerative mitral valve disease.[J].Prog Cardiovasc Dis2009;51(6):454-459.
[17]Ahmed MI, McGiffin DC, O'Rourke RA, Dell'Italia LJ. Mitralregurgitation.[J].Curr Probl Cardiol2009;34(3):93-136.
[18]Zigelman CZ, Edelstein PM. Aortic valve stenosis.[J].Anesthesiol Clin2009;27(3):519-532, table of contents.
[19]Spann JF, Jr., Sands MJ, Jr. The incidence and significance of atrial dysrhythmiasin rheumatic valvular disease.[J].Cardiovasc Clin1973;5(2):115-129.
[20]Kabukcu M, Arslantas E, Ates I, Demircioglu F, Ersel F. Clinical,echocardiographic, and hemodynamic characteristics of rheumatic mitral valvestenosis and atrial fibrillation.[J].Angiology2005;56(2):159-163.
[21]Kuwaki K, Kawaharada N, Morishita K, et al. Mitral valve repair versusreplacement in simultaneous mitral and aortic valve surgery for rheumaticdisease.[J].Ann Thorac Surg2007;83(2):558-563.
[22]Michelena HI, Topilsky Y, Suri R, Enriquez-Sarano M. Degenerative mitral valveregurgitation: understanding basic concepts and new developments.[J].PostgradMed2011;123(2):56-69.
[23]Foster E. Clinical practice. Mitral regurgitation due to degenerative mitral-valvedisease.[J].N Engl J Med2010;363(2):156-165.
[24]Faber L, Lamp B. Mitral valve regurgitation and left ventricular systolicdysfunction: corrective surgery or cardiac resynchronizationtherapy?[J].Herzschrittmacherther Elektrophysiol2008;19Suppl1:52-59.
[25]Anderson CA, Chitwood WR. Advances in mitral valve repair.[J].Future Cardiol2009;5(5):511-516.
[26]Augoustides JG, Atluri P. Progress in mitral valve disease: understanding therevolution.[J].J Cardiothorac Vasc Anesth2009;23(6):916-923.
[27]Rosenhek R, Maurer G. Management of valvular mitral regurgitation: theimportance of risk stratification.[J].J Cardiol2010;56(3):255-261.
[28]Pomerantzeff PM, Brandao CM, Leite Filho OA, et al. Mitral valve repair inrheumatic patients with mitral insuficiency: twenty years of techniques andresults.[J].Rev Bras Cir Cardiovasc2009;24(4):485-489.
[29]Kim JB, Kim HJ, Moon DH, et al. Long-term outcomes after surgery forrheumatic mitral valve disease: valve repair versus mechanical valvereplacement.[J].Eur J Cardiothorac Surg2010;37(5):1039-1046.
[30]Antunes MJ. Valve repair for rheumatic mitral regurgitation: still worthwhile?[J].JHeart Valve Dis2011;20(3):254-256.
[31]Kuduvalli M, Grayson AD, Au J, Grotte G, Bridgewater B, Fabri BM. Amulti-centre additive and logistic risk model for in-hospital mortality followingaortic valve replacement.[J].Eur J Cardiothorac Surg2007;31(4):607-613.
[32]Thomas M. The global experience with percutaneous aortic valvereplacement.[J].JACC Cardiovasc Interv2010;3(11):1103-1109.
[33]Mookadam F, Jalal U, Wilansky S. Aortic valve disease: preventable orinevitable?[J].Future Cardiol2010;6(6):777-783.
[34]Nissinen J, Biancari F, Wistbacka JO, et al. Safe time limits of aorticcross-clamping and cardiopulmonary bypass in adult cardiac surgery.[J].Perfusion2009;24(5):297-305.
[35]Bar-El Y, Adler Z, Kophit A, et al. Myocardial protection in operations requiringmore than2h of aortic cross-clamping.[J].Eur J Cardiothorac Surg1999;15(3):271-275.
[36]Higami T, Yamamoto S, Ogawa K, et al.[Myocardial protection with retrogradecold blood cardioplegia in prolonged aortic cross-clamping].[J].Rinsho KyobuGeka1988;8(4):374-379.
[37]Tanaka H, Yoshida T, Nakagawa T, et al.[Study of cases with prolonged aorticcross-clamping times (>240min) using cold K(+)-Mg++cardioplegia].[J].Rinsho Kyobu Geka1988;8(3):270-274.
[38]Berglin E, Feddersen K, Gatzinsky P, Rohsman B, Wallentin I, William-Olsson G.Aortic cross-clamping for more than2hours in open-heart surgery. Early resultsin87patients.[J].Thorac Cardiovasc Surg1983;31(5):273-276.
[1] Nashef SA, Roques F, Sharples LD, et al. EuroSCORE II. Eur J CardiothoracSurg2012Apr;41(4):734-45.
[2] O'Brien SM, Shahian DM, Filardo G, et al. The Society of Thoracic Surgeons2008cardiac surgery risk models: part2--isolated valve surgery. Ann ThoracSurg2009Jul;88(1Suppl):S23-42.
[3] Shahian DM, O'Brien SM, Filardo G, et al. The Society of Thoracic Surgeons2008cardiac surgery risk models: part3--valve plus coronary artery bypassgrafting surgery. Ann Thorac Surg2009Jul;88(1Suppl):S43-62.
[4] Shahian DM, O'Brien SM, Filardo G, et al. The Society of Thoracic Surgeons2008cardiac surgery risk models: part1--coronary artery bypass grafting surgery.Ann Thorac Surg2009Jul;88(1Suppl):S2-22.
[5]郑哲,张路,胡盛寿.中国冠状动脉旁路移植手术风险评估.中华心血管病杂志2010;38(10).
[6] Grant SW, Hickey GL, Dimarakis I, et al. How does EuroSCORE II perform inUK cardiac surgery; an analysis of23740patients from the Society forCardiothoracic Surgery in Great Britain and Ireland National Database. Heart2012Sep7.
[7] Di Dedda U, Pelissero G, Agnelli B, De Vincentiis C, Castelvecchio S, RanucciM. Accuracy, calibration and clinical performance of the new EuroSCORE IIrisk stratification system. Eur J Cardiothorac Surg2012Jul20.
[8] Biancari F, Vasques F, Mikkola R, Martin M, Lahtinen J, Heikkinen J. Validationof EuroSCORE II in patients undergoing coronary artery bypass surgery. AnnThorac Surg2012Jun;93(6):1930-5.
[9]中国心血管外科注册登记研究协作组. SinoSCORE对手术风险的评估作用.中华胸心血管外科杂志2011;27(2).
[10]中国心血管外科注册登记研究协作组. SinoSCORE对老年心血管外科病人的手术风险预测作用.中华胸心血管外科杂志2011;27(2).
[11]中国心血管外科注册登记研究协作组.非体外循环冠状动脉旁路移植术后早期死亡风险预测——SinoSCORE与EuroSCORE评分的对比.中华胸心血管外科杂志2011;27(2).
[12]中国心血管外科注册登记研究协作组. SinoSCORE预测瓣膜手术死亡风险.中华胸心血管外科杂志2011;27(2).
[13]苏丕雄,刘岩,顾松,颜钧,张希涛,赵洋. SinoSCORE对CABG术后死亡和并发症的预测价值.中华胸心血管外科杂志2011;27(2).
[14]郭惠明,吴若彬,肖学钧, et al. SinoSCORE预测心血管外科手术病死率——广东心血管病研究所经验.中华胸心血管外科杂志2011;27(2).
[15] Chalmers J, Pullan M, Fabri B, et al. Validation of EuroSCORE II in a moderncohort of patients undergoing cardiac surgery. Eur J Cardiothorac Surg2012Jul24.
[16] Basraon J, Chandrashekhar YS, John R, et al. Comparison of risk scores toestimate perioperative mortality in aortic valve replacement surgery. Ann ThoracSurg2011Aug;92(2):535-40.
[1] NASHEF S A, ROQUES F, SHARPLES L D, et al. EuroSCORE II [J]. Eur JCardiothorac Surg,2012,41(4):734-45.
[2] ROQUES F, MICHEL P, GOLDSTONE A R, et al. The logistic EuroSCORE [J].Eur Heart J,2003,24(9):881-2.
[3] NASHEF S A, ROQUES F, MICHEL P, et al. European system for cardiacoperative risk evaluation (EuroSCORE)[J]. Eur J Cardiothorac Surg,1999,16(1):9-13.
[4] WANG C, YAO F, HAN L, et al. Validation of the European system for cardiacoperative risk evaluation (EuroSCORE) in Chinese heart valve surgery patients[J]. J Heart Valve Dis,2010,19(1):21-7.
[5] SHAHIAN D M, O'BRIEN S M, FILARDO G, et al. The Society of ThoracicSurgeons2008cardiac surgery risk models: part1--coronary artery bypassgrafting surgery [J]. Ann Thorac Surg,2009,88(1Suppl): S2-22.
[6] SHAHIAN D M, O'BRIEN S M, FILARDO G, et al. The Society of ThoracicSurgeons2008cardiac surgery risk models: part3--valve plus coronary arterybypass grafting surgery [J]. Ann Thorac Surg,2009,88(1Suppl): S43-62.
[7] O'BRIEN S M, SHAHIAN D M, FILARDO G, et al. The Society of ThoracicSurgeons2008cardiac surgery risk models: part2--isolated valve surgery [J].Ann Thorac Surg,2009,88(1Suppl): S23-42.
[8] HANNAN E L, FARRELL L S, WECHSLER A, et al. The new york risk scorefor in-hospital and30-day mortality for coronary artery bypass graft surgery [J].Ann Thorac Surg,2013,95(1):46-52.
[9] HANNAN E L, WU C, BENNETT E V, et al. Risk index for predictingin-hospital mortality for cardiac valve surgery [J]. Ann Thorac Surg,2007,83(3):921-9.
[10] HANNAN E L, KILBURN H, JR., RACZ M, et al. Improving the outcomes ofcoronary artery bypass surgery in New York State [J]. JAMA,1994,271(10):761-6.
[11] O'CONNOR G T, PLUME S K, OLMSTEAD E M, et al. Multivariate predictionof in-hospital mortality associated with coronary artery bypass graft surgery.Northern New England Cardiovascular Disease Study Group [J]. Circulation,1992,85(6):2110-8.
[12] EDWARDS F H, CLARK R E, SCHWARTZ M. Coronary artery bypass grafting:the Society of Thoracic Surgeons National Database experience [J]. Ann ThoracSurg,1994,57(1):12-9.
[13] RANUCCI M, CASTELVECCHIO S, MENICANTI L, et al. Risk of assessingmortality risk in elective cardiac operations: age, creatinine, ejection fraction,and the law of parsimony [J]. Circulation,2009,119(24):3053-61.
[1] O'BRIEN S M, SHAHIAN D M, FILARDO G, et al. The Society of ThoracicSurgeons2008cardiac surgery risk models: part2--isolated valve surgery [J]. AnnThorac Surg,2009,88(1Suppl): S23-42.
[2] SHAHIAN D M, O'BRIEN S M, FILARDO G, et al. The Society of ThoracicSurgeons2008cardiac surgery risk models: part3--valve plus coronary arterybypass grafting surgery [J]. Ann Thorac Surg,2009,88(1Suppl): S43-62.
[3] SHAHIAN D M, O'BRIEN S M, FILARDO G, et al. The Society of ThoracicSurgeons2008cardiac surgery risk models: part1--coronary artery bypassgrafting surgery [J]. Ann Thorac Surg,2009,88(1Suppl): S2-22.
[4]郑哲,张路,胡盛寿.中国冠状动脉旁路移植手术风险评估[J].中华心血管病杂志,2010,38(10):
[5] NASHEF S A, ROQUES F, SHARPLES L D, et al. EuroSCORE II [J]. Eur JCardiothorac Surg,2012,41(4):734-45.
[6] GRANT S W, HICKEY G L, DIMARAKIS I, et al. How does EuroSCORE IIperform in UK cardiac surgery; an analysis of23740patients from the Societyfor Cardiothoracic Surgery in Great Britain and Ireland National Database [J].Heart,2012,
[7] DI DEDDA U, PELISSERO G, AGNELLI B, et al. Accuracy, calibration andclinical performance of the new EuroSCORE II risk stratification system [J]. EurJ Cardiothorac Surg,2012,
[8] NOYEZ L, KIEVIT P C, VAN SWIETEN H A, et al. Cardiac operative riskevaluation: The EuroSCORE II, does it make a real difference?[J]. Neth Heart J,2012,
[9]中国心血管外科注册登记研究协作组. SinoSCORE预测瓣膜手术死亡风险[J].中华胸心血管外科杂志,2011,27(2):
[10]中国心血管外科注册登记研究协作组. SinoSCORE对老年心血管外科病人的手术风险预测作用[J].中华胸心血管外科杂志,2011,27(2):
[1] DALEY J. Criteria by which to evaluate risk-adjusted outcomes programs in cardiac surgery[J]. The Annals of Thoracic Surgery,1994,58(6):1827-35.
[2] IEZZONI L I. The risks of risk adjustment [J]. JAMA,1997,278(19):1600-7.
[3] TU J V, SYKORA K, NAYLOR C D. Assessing the outcomes of coronary artery bypass graftsurgery: how many risk factors are enough? Steering Committee of the Cardiac CareNetwork of Ontario [J]. J Am Coll Cardiol,1997,30(5):1317-23.
[4] LUFT H S, ROMANO P S. Chance, continuity, and change in hospital mortality rates.Coronary artery bypass graft patients in California hospitals,1983to1989[J]. JAMA,1993,270(3):331-7.
[5] GRUNKEMEIER G L, PAYNE N, JIN R, et al. Propensity score analysis of stroke afteroff-pump coronary artery bypass grafting [J]. Ann Thorac Surg,2002,74(2):301-5.
[6] BLACKSTONE E H. Comparing apples and oranges [J]. J Thorac Cardiovasc Surg,2002,123(1):8-15.
[7] EDWARDS F H, ALBUS R A, ZAJTCHUK R, et al. Use of a Bayesian statistical model forrisk assessment in coronary artery surgery [J]. Ann Thorac Surg,1988,45(4):437-40.
[8] PARSONNET V, DEAN D, BERNSTEIN A D. A method of uniform stratification of risk forevaluating the results of surgery in acquired adult heart disease [J]. Circulation,1989,79(6Pt2): I3-12.
[9] HIGGINS T L, ESTAFANOUS F G, LOOP F D, et al. Stratification of morbidity andmortality outcome by preoperative risk factors in coronary artery bypass patients. A clinicalseverity score [J]. JAMA,1992,267(17):2344-8.
[10] O'CONNOR G T, PLUME S K, OLMSTEAD E M, et al. Multivariate prediction ofin-hospital mortality associated with coronary artery bypass graft surgery. Northern NewEngland Cardiovascular Disease Study Group [J]. Circulation,1992,85(6):2110-8.
[11] EAGLE K A, GUYTON R A, DAVIDOFF R, et al. ACC/AHA guidelines for coronary arterybypass graft surgery: executive summary and recommendations: A report of the AmericanCollege of Cardiology/American Heart Association Task Force on Practice Guidelines(Committee to revise the1991guidelines for coronary artery bypass graft surgery)[J].Circulation,1999,100(13):1464-80.
[12] NOWICKI E R, BIRKMEYER N J, WEINTRAUB R W, et al. Multivariable prediction ofin-hospital mortality associated with aortic and mitral valve surgery in Northern NewEngland [J]. Ann Thorac Surg,2004,77(6):1966-77.
[13] HANNAN E L, KILBURN H, JR., RACZ M, et al. Improving the outcomes of coronaryartery bypass surgery in New York State [J]. JAMA,1994,271(10):761-6.
[14] HANNAN E L, WU C, BENNETT E V, et al. Risk index for predicting in-hospital mortalityfor cardiac valve surgery [J]. Ann Thorac Surg,2007,83(3):921-9.
[15] WU C, CAMACHO F T, WECHSLER A S, et al. Risk score for predicting long-termmortality after coronary artery bypass graft surgery [J]. Circulation,2012,125(20):2423-30.
[16] HANNAN E L, FARRELL L S, WECHSLER A, et al. The new york risk score forin-hospital and30-day mortality for coronary artery bypass graft surgery [J]. Ann ThoracSurg,2013,95(1):46-52.
[17] EDWARDS F H, CLARK R E, SCHWARTZ M. Coronary artery bypass grafting: theSociety of Thoracic Surgeons National Database experience [J]. Ann Thorac Surg,1994,57(1):12-9.
[18] EDWARDS F H, GROVER F L, SHROYER A L, et al. The Society of Thoracic SurgeonsNational Cardiac Surgery Database: current risk assessment [J]. Ann Thorac Surg,1997,63(3):903-8.
[19] SHROYER A L, GROVER F L, EDWARDS F H.1995coronary artery bypass risk model:The Society of Thoracic Surgeons Adult Cardiac National Database [J]. Ann Thorac Surg,1998,65(3):879-84.
[20] LIPPMANN R P, SHAHIAN D M. Coronary artery bypass risk prediction using neuralnetworks [J]. Ann Thorac Surg,1997,63(6):1635-43.
[21] SHROYER A L, COOMBS L P, PETERSON E D, et al. The Society of Thoracic Surgeons:30-day operative mortality and morbidity risk models [J]. Ann Thorac Surg,2003,75(6):1856-64; discussion64-5.
[22] RANKIN J S, HAMMILL B G, FERGUSON T B, JR., et al. Determinants of operativemortality in valvular heart surgery [J]. J Thorac Cardiovasc Surg,2006,131(3):547-57.
[23] SHAHIAN D M, O'BRIEN S M, FILARDO G, et al. The Society of Thoracic Surgeons2008cardiac surgery risk models: part1--coronary artery bypass grafting surgery [J]. Ann ThoracSurg,2009,88(1Suppl): S2-22.
[24] SHAHIAN D M, O'BRIEN S M, FILARDO G, et al. The Society of Thoracic Surgeons2008cardiac surgery risk models: part3--valve plus coronary artery bypass grafting surgery [J].Ann Thorac Surg,2009,88(1Suppl): S43-62.
[25] O'BRIEN S M, SHAHIAN D M, FILARDO G, et al. The Society of Thoracic Surgeons2008cardiac surgery risk models: part2--isolated valve surgery [J]. Ann Thorac Surg,2009,88(1Suppl): S23-42.
[26] SHAHIAN D M, EDWARDS F H. The Society of Thoracic Surgeons2008cardiac surgeryrisk models: introduction [J]. Ann Thorac Surg,2009,88(1Suppl): S1.
[27] SHAHIAN D M, O'BRIEN S M, SHENG S, et al. Predictors of Long-Term Survival AfterCoronary Artery Bypass Grafting Surgery: Results From the Society of Thoracic SurgeonsAdult Cardiac Surgery Database (The ASCERT Study)[J]. Circulation,2012,125(12):1491-500.
[28] TU J V, JAGLAL S B, NAYLOR C D. Multicenter validation of a risk index for mortality,intensive care unit stay, and overall hospital length of stay after cardiac surgery. SteeringCommittee of the Provincial Adult Cardiac Care Network of Ontario [J]. Circulation,1995,91(3):677-84.
[29] IVANOV J, TU J V, NAYLOR C D. Ready-made, recalibrated, or Remodeled? Issues in theuse of risk indexes for assessing mortality after coronary artery bypass graft surgery [J].Circulation,1999,99(16):2098-104.
[30] KURKI T S, KATAJA M. Preoperative prediction of postoperative morbidity in coronaryartery bypass grafting [J]. Ann Thorac Surg,1996,61(6):1740-5.
[31] MAGOVERN J A, SAKERT T, MAGOVERN G J, et al. A model that predicts morbidity andmortality after coronary artery bypass graft surgery [J]. J Am Coll Cardiol,1996,28(5):1147-53.
[32] PONS J M, GRANADOS A, ESPINAS J A, et al. Assessing open heart surgery mortality inCatalonia (Spain) through a predictive risk model [J]. Eur J Cardiothorac Surg,1997,11(3):415-23.
[33] BRIDGEWATER B, NEVE H, MOAT N, et al. Predicting operative risk for coronary arterysurgery in the United Kingdom: a comparison of various risk prediction algorithms [J]. Heart,1998,79(4):350-5.
[34] MOZES B, OLMER L, GALAI N, et al. A national study of postoperative mortalityassociated with coronary artery bypass grafting in Israel. ISCAB Consortium. IsraelCoronary Artery Bypass Study [J]. Ann Thorac Surg,1998,66(4):1254-62; discussion63.
[35] WONG D T, CHENG D C, KUSTRA R, et al. Risk factors of delayed extubation, prolongedlength of stay in the intensive care unit, and mortality in patients undergoing coronary arterybypass graft with fast-track cardiac anesthesia: a new cardiac risk score [J]. Anesthesiology,1999,91(4):936-44.
[36] NASHEF S A, ROQUES F, MICHEL P, et al. European system for cardiac operative riskevaluation (EuroSCORE)[J]. Eur J Cardiothorac Surg,1999,16(1):9-13.
[37] ROQUES F, NASHEF S A, MICHEL P, et al. Risk factors and outcome in European cardiacsurgery: analysis of the EuroSCORE multinational database of19030patients [J]. Eur JCardiothorac Surg,1999,15(6):816-22; discussion22-3.
[38] ROQUES F, MICHEL P, GOLDSTONE A R, et al. The logistic EuroSCORE [J]. Eur Heart J,2003,24(9):881-2.
[39] NASHEF S A, ROQUES F, SHARPLES L D, et al. EuroSCORE II [J]. Eur J CardiothoracSurg,2012,41(4):734-45.
[40] BERNSTEIN A D, PARSONNET V. Bedside estimation of risk as an aid fordecision-making in cardiac surgery [J]. Ann Thorac Surg,2000,69(3):823-8.
[41] ZAROFF J G, DITOMMASO D G, BARRON H V. A risk model derived from the NationalRegistry of Myocardial Infarction2database for predicting mortality after coronary arterybypass grafting during acute myocardial infarction [J]. Am J Cardiol,2002,90(1):1-4.
[42] HUIJSKES R V, ROSSEEL P M, TIJSSEN J G. Outcome prediction in coronary arterybypass grafting and valve surgery in the Netherlands: development of the Amphiascore andits comparison with the Euroscore [J]. Eur J Cardiothorac Surg,2003,24(5):741-9.
[43] CHAUDHURI N, JAMES J, SHEIKH A, et al. Intestinal ischaemia following cardiacsurgery: a multivariate risk model [J]. Eur J Cardiothorac Surg,2006,29(6):971-7.
[44] MOTOMURA N, MIYATA H, TSUKIHARA H, et al. First report on30-day and operativemortality in risk model of isolated coronary artery bypass grafting in Japan [J]. Ann ThoracSurg,2008,86(6):1866-72.
[45] MOTOMURA N, MIYATA H, TSUKIHARA H, et al. Risk model of thoracic aortic surgeryin4707cases from a nationwide single-race population through a web-based data entrysystem: the first report of30-day and30-day operative outcome risk models for thoracicaortic surgery [J]. Circulation,2008,118(14Suppl): S153-9.
[46] MOTOMURA N, MIYATA H, TSUKIHARA H, et al. Risk model of valve surgery in Japanusing the Japan Adult Cardiovascular Surgery Database [J]. J Heart Valve Dis,2010,19(6):684-91.
[47] MIYATA H, MOTOMURA N, TSUKIHARA H, et al. Risk models including high-riskcardiovascular procedures: clinical predictors of mortality and morbidity [J]. Eur JCardiothorac Surg,2011,39(5):667-74.
[48] MIYATA H, MOTOMURA N, YOZU R, et al. Cardiovascular surgery risk prediction fromthe patient's perspective [J]. J Thorac Cardiovasc Surg,2011,142(3): e71-6.
[49] TOUMPOULIS I K, CHAMOGEORGAKIS T P, ANGOURAS D C, et al. Independentpredictors for early and long-term mortality after heart valve surgery [J]. J Heart Valve Dis,2008,17(5):548-56.
[50] CAROSELLA V C, NAVIA J L, AL-RUZZEH S, et al. The first Latin-American riskstratification system for cardiac surgery: can be used as a graphic pocket-card score [J].Interact Cardiovasc Thorac Surg,2009,9(2):203-8.
[51] CISLAGHI F, CONDEMI A M, CORONA A. Predictors of prolonged mechanical ventilationin a cohort of5123cardiac surgical patients [J]. Eur J Anaesthesiol,2009,26(5):396-403.
[52] HERMAN C, KAROLAK W, YIP A M, et al. Predicting prolonged intensive care unit lengthof stay in patients undergoing coronary artery bypass surgery--development of an entirelypreoperative scorecard [J]. Interact Cardiovasc Thorac Surg,2009,9(4):654-8.
[53] REID C, BILLAH B, DINH D, et al. An Australian risk prediction model for30-daymortality after isolated coronary artery bypass: the AusSCORE [J]. J Thorac Cardiovasc Surg,2009,138(4):904-10.
[54] BILLAH B, REID C M, SHARDEY G C, et al. A preoperative risk prediction model for30-day mortality following cardiac surgery in an Australian cohort [J]. Eur J CardiothoracSurg,2010,37(5):1086-92.
[55] RANUCCI M, CASTELVECCHIO S, MENICANTI L A, et al. An adjusted EuroSCOREmodel for high-risk cardiac patients [J]. Eur J Cardiothorac Surg,2009,36(5):791-7.
[56] RANUCCI M, CASTELVECCHIO S, MENICANTI L, et al. Risk of assessing mortality riskin elective cardiac operations: age, creatinine, ejection fraction, and the law of parsimony [J].Circulation,2009,119(24):3053-61.
[57] CADORE M P, GUARAGNA J C, ANACKER J F, et al. A score proposal to evaluatesurgical risk in patients submitted to myocardial revascularization surgery [J]. Rev Bras CirCardiovasc,2010,25(4):447-56.
[58] MAGEDANZ E H, BODANESE L C, GUARAGNA J C, et al. Risk score elaboration formediastinitis after coronary artery bypass grafting [J]. Rev Bras Cir Cardiovasc,2010,25(2):154-9.
[59] MICELI A, DUGGAN S M, CAPOUN R, et al. A clinical score to predict the need forintraaortic balloon pump in patients undergoing coronary artery bypass grafting [J]. AnnThorac Surg,2010,90(2):522-6.
[60] GUO L X, MENG X, ZHANG Z G, et al. Analysis of risk factors for valve replacements in5,128cases from a single heart center in China [J]. Chin Med J (Engl),2010,123(24):3509-14.
[61]郑哲,张路,胡盛寿.中国冠状动脉旁路移植手术风险评估[J].中华心血管病杂志,2010,38(10):
[62] AMBROSETTI M, TRAMARIN R, GRIFFO R, et al. Late postoperative atrial fibrillationafter cardiac surgery: a national survey within the cardiac rehabilitation setting [J]. JCardiovasc Med (Hagerstown),2011,12(6):390-5.
[63] RAHMANIAN P B, KWIECIEN G, LANGEBARTELS G, et al. Logistic risk modelpredicting postoperative renal failure requiring dialysis in cardiac surgery patients [J]. Eur JCardiothorac Surg,2011,40(3):701-7.
[64] SINGH T P, ALMOND C S, SEMIGRAN M J, et al. Risk prediction for early in-hospitalmortality following heart transplantation in the United States [J]. Circ Heart Fail,2012,5(2):259-66.
[65] WEISS E S, ALLEN J G, KILIC A, et al. Development of a quantitative donor risk index topredict short-term mortality in orthotopic heart transplantation [J]. J Heart Lung Transplant,2012,31(3):266-73.
[66] TANAKA S, SAKATA R, MARUI A, et al. Predicting long-term mortality after firstcoronary revascularization:-the Kyoto model [J]. Circ J,2012,76(2):328-34.
[67] O'CONNOR G T, PLUME S K, OLMSTEAD E M, et al. A regional prospective study ofin-hospital mortality associated with coronary artery bypass grafting. The Northern NewEngland Cardiovascular Disease Study Group [J]. JAMA,1991,266(6):803-9.
[68] GRIFFITH B P, HATTLER B G, HARDESTY R L, et al. The need for accurate risk-adjustedmeasures of outcome in surgery. Lessons learned through coronary artery bypass [J]. AnnSurg,1995,222(4):593-8; discussion8-9.
[69] NILSSON J, OHLSSON M, THULIN L, et al. Risk factor identification and mortalityprediction in cardiac surgery using artificial neural networks [J]. J Thorac Cardiovasc Surg,2006,132(1):12-9.
[70] HARRELL F E, JR., LEE K L, MARK D B. Multivariable prognostic models: issues indeveloping models, evaluating assumptions and adequacy, and measuring and reducingerrors [J]. Stat Med,1996,15(4):361-87.
[71] NASHEF S A, ROQUES F, HAMMILL B G, et al. Validation of European System forCardiac Operative Risk Evaluation (EuroSCORE) in North American cardiac surgery [J]. EurJ Cardiothorac Surg,2002,22(1):101-5.
[72] GRUNKEMEIER G L, ZERR K J, JIN R. Cardiac surgery report cards: making the grade [J].Ann Thorac Surg,2001,72(6):1845-8.