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The French Score for Predicting Operative Mortality in Adult Patients Having Open Heart Surgery

Purpose: To predict operative mortality in adults undergoing open heart surgery using the prognostic score developed in France.

Description

A prognostic score for adult patients having open heart surgery was developed at French cardiac surgery centers.


Features of the French score:

(1) Component factors were selected by multivariate analysis.

(2) Factors shared with the Parsonnet system: age, ejection fraction, reoperation, valve added to coronary bypass procedure.

(3) Factors from Parsonnet scoring system not used: age, hypertension, left ventricular aneurysm, intra-aortic balloon pump, morbid obesity, mitral and aortic valve surgery.

(4) Variables not used due to variation between centers or difficulty in defining clearly: unstable angina, peripheral vascular disease, chronic pulmonary obstructive disease, congestive heart failure.

 

Risk Factor

Finding

Points

age in years

< 70

0

 

70-74

3

 

75-79

4

 

>= 80

5

chronic renal failure

absent

0

 

creatinine >= 200 µmol/L and not on dialysis

5

 

patient on dialysis

6

ejection fraction

> 50%

0

 

31 – 50%

2

 

<= 30%

5

saphenous vein graft only

no

0

 

yes

2

reoperation

no

0

 

yes

2

tricuspid valve surgery

no

0

 

yes

4

valve (mitral or aortic) and (coronary artery bypass graft) CABG

no

0

 

yes

2

 

where:

• The internal mammary artery was preferred over the saphenous vein for coronary artery bypass procedures, with the saphenous vein graft used in emergency or higher risk patients.

 

Type of Critical Situations

Points

myocardial infarction < 48 hours prior to surgery

4

ventricular tachycardia or fibrillation

4

preoperative intubation

10

cardiac transplantation

9

post-MI ventricular septal defect (VSD)

8

acute aortic dissection

13

pulmonary embolectomy

15

 

French score =

= (points for risk factors) + (points for critical situations)

 

Interpretation:

• Minimum score: 0

• Maximum score: > 50

 

French Score

Mortality Rate

< 2

2%

2-3

3.9%

4-6

6.1%

> 6

21.2%

after Figure 1, page 435

 

Limitations:

• Scores much higher than 6 would be expected to have a higher mortality rate than that shown.


 


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Specialty

Objective

ICD-10