Risk Assessment Scores in Cardiac Surgery

This chapter discusses the importance of cardiac surgical risk scoring models in classifying risk in adult patients. These scores first came into construct in the 1980s when the rate of mortality following coronary bypass graft surgery began to increase. Since this time, numerous scoring systems have been developed to define patient risk factors. The first widely used risk model was the initial Parsonnet score developed in 1989, which predicted cardiac surgical mortality based on preoperative risk factors thought to be clinically significant. Today, the most commonly used risk assessment tools for cardiac surgical patients are the European System for Cardiac Operative Risk Evaluation II and the Society of Thoracic Surgeons risk score. However, neither of these 2 major scoring systems assesses frailty. Frailty is consistently associated with a greater risk of morbidity and mortality in patients undergoing transcatheter aortic valve replacement procedures. The risk associated with frailty following open cardiac surgical procedures is less clear.