Шкала Euroscore II

Оценка риска внутрибольничной смерти после кардиохирургических операций.

EuroSCORE был разработан для прогнозирования внутрибольничной смертности после операций на сердце и опубликован в 1999 году.

В результате прогресса в предоперационном скрининге, хирургических методах и интенсивной терапии риск, связанный с кардиохирургией, снизился. Было сочтено, что первоначальный вариант EuroSCORE больше не подходит для стратификации рисков.

EuroSCORE II был разработан на основе более современной базы данных пациентов и, по-видимому, снижает переоценку расчетного риска.

Важные определения и пояснения факторов риска

NYHA классификация одышки:

• I: no symptoms on moderate exertion
• II: symptoms on moderate exertion
• III: symptoms on light exertion
• IV: symptoms at rest

CCS class 4 angina:

• inability to perform any activity without angina or angina at rest

Extracardiac arteriopathy includes 1 or more of the following:

• claudication
• carotid occlusion or >50% stenosis (North American Symptomatic Carotid Endarterectomy Trial criteria)
• amputation for arterial disease
• previous or planned intervention on the abdominal aorta, limb arteries or carotids

Poor mobility:

• Severe impairment of mobility secondary to musculoskeletal or neurological dysfunction

Previous cardiac surgery:

• One or more previous major cardiac operation involving opening the pericardium

Renal dysfunction

This is assessed using the Cockcroft–Gault formula and falls into three categories:

• >85 ml/min
• 51–85 ml/min
• CC ≤ 50 ml/min
• on dialysis (regardless of serum creatinine)

Active endocarditis:

• Patients still on antibiotic treatment for endocarditis at the time of surgery

Critical preoperative state:

Any one or more of the following occurring preoperatively in the same hospital admission as the operation:

• ventricular tachycardia or fibrillation or aborted sudden death
• cardiac massage
• ventilation before arrival in the anaesthetic room
• inotropes
• intra-aortic balloon counterpulsation or ventricular-assist device before arrival in the anaesthetic room
• acute renal failure (anuria or oliguria <10 ml/h)

LV function or LVEF:

• good (LVEF 51% or more)
• moderate (LVEF 31–50%)
• poor (LVEF 21–30%)
• very poor (LVEF 20% or less)

Urgency of procedure

• elective: routine admission for operation
• urgent: patients not electively admitted for operation but who require surgery on the current admission for medical reasons and cannot be discharged without a definitive procedure
• emergency: operation before the beginning of the next working day after decision to operate
• salvage: patients requiring cardiopulmonary resuscitation (external cardiac massage) en route to the operating theatre or before induction of anaesthesia. This does not include cardiopulmonary resuscitation after induction of anaesthesia

Recent MI:

Within 90 days before operation

• Weight of procedure

This measures the extent or size of the intervention. The baseline is isolated CABG: operations ‘heavier’ than the baseline are in three categories:

• isolated non-CABG major procedure (e.g. single valve procedure, replacement of ascending aorta, correction of septal defect, etc.);
• two major procedures (e.g. CABG + AVR), or CABG + mitral valve repair (MVR), or AVR + replacement of ascending aorta, or CABG + maze procedure, or AVR + MVR, etc.);
• three major procedures or more (e.g. AVR + MVR + CABG, or MVR + CABG + tricuspid annuloplasty, etc.), or aortic root replacement when it includes AVR or repair + coronary reimplantation + root and ascending replacement).

Only major cardiac procedures count towards to the total. Examples of procedures which do not qualify are: sternotomy, closure of sternum, myocardial biopsy, insertion of intra-aortic balloon, pacing wires, closure of aortotomy, closure of atriotomy; removal of atrial appendage, coronary endarterectomy as part of CABG, etc.