Predictive value of Euroscore II as compared to intermacs levels in patients undergoing left ventricular assist device therapy

Objectives: Left ventricular assist devices (LVAD) have become a widespread option for the effective treatment for heart failure. Consequently, the need for postoperative survival estimation increases. We assumed that the EuroScore II might be useful for predicting long-term outcome after LVAD use.

Methods: In this retrospective analysis, all 40 patients were consecutively followed for full 12 months after having received a LVAD (Thoratec HeartMate II ™) in our institution between 2008 and April 2011. Mean age was 58 years, 13 patients were female. The intention to treat was destination therapy in 25%. 52.5% were classified in INTERMACS Levels I+II. Postoperative survival was correlated both to INTERMACS™ levels and to EuroScoreII data with patients classified in 3 categories: Patients were classified via the EuroScoreII as low ( < 25%), middle and high (>55%) risk and in Intermacs Level groups I, II and III + IV.

Results: The survival was 87.5% for 30 days and 70% for 1 year (28/40pts). Within the different INTERMACS™ levels, survival reached 58,3% for INTERMACS™ levels I and 88,9% for level II compared to 68.4% at combined levels III and IV. On the other hand, classification by EuroScoreII showed a 12 month survival of 16.7% (1/6 pts) in high risk patients compared to 89.5% (17/19pts) in low risk patients. Patients of medium risk (EuroScoreII between 25 and 55%) showed a survival rate of 66.7%. Fisher's exact test revealed a significant predictive value for classification by EuroScoreII (p = 0.003) but not for INTERMACS™ levels.

Conclusion: These results support the assumption that EuroScoreII risk classification may be useful to predict long-term survival in LVAD patients. In our observation, it proved to be superior to INTERMACS™ classification.

SC114Fig. 1: Postoperative survival of patients classified in 3 categories of EuroScoreII