| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 2004;25:911-924
© 2004 Elsevier Science NL
Invited paper |
The Children's Hospital, University of Colorado, 1056 East 19th Avenue, Denver, CO 80218, USA
Received 25 October 2003; received in revised form 2 February 2004; accepted 16 March 2004.
* Corresponding author. Tel.: +1-303-8616624; fax: +1-303-7648022
e-mail: lacour-gayet.francois{at}tchden.org
Abstract
Objectives: Quality control is difficult to achieve in Congenital Heart Surgery (CHS) because of the diversity of the procedures. It is particularly needed, considering the potential adverse outcomes associated with complex cases. The aim of this project was to develop a new method based on the complexity of the procedures. Methods: The Aristotle project, involving a panel of expert surgeons, started in 1999 and included 50 pediatric surgeons from 23 countries, representing the EACTS, STS, ECHSA and CHSS. The complexity was based on the procedures as defined by the STS/EACTS International Nomenclature and was undertaken in two steps: the first step was establishing the Basic Score, which adjusts only the complexity of the procedures. It is based on three factors: the potential for mortality, the potential for morbidity and the anticipated technical difficulty. A questionnaire was completed by the 50 centers. The second step was the development of the Comprehensive Aristotle Score, which further adjusts the complexity according to the specific patient characteristics. It includes two categories of complexity factors, the procedure dependent and independent factors. After considering the relationship between complexity and performance, the Aristotle Committee is proposing that: Performance=ComplexityxOutcome. Results: The Aristotle score, allows precise scoring of the complexity for 145 CHS procedures. One interesting notion coming out of this study is that complexity is a constant value for a given patient regardless of the center where he is operated. The Aristotle complexity score was further applied to 26 centers reporting to the EACTS congenital database. A new display of centers is presented based on the comparison of hospital survival to complexity and to our proposed definition of performance. Conclusion: A complexity-adjusted method named the Aristotle Score, based on the complexity of the surgical procedures has been developed by an international group of experts. The Aristotle score, electronically available, was introduced in the EACTS and STS databases. A validation process evaluating its predictive value is being developed.
Key Words: Congenital heart surgery • Complexity • Risk stratification • Accreditation • Database • Quality of care
This article has been cited by other articles:
|
|
 |
|
  S. M. O'Brien, D. R. Clarke, J. P. Jacobs, M. L. Jacobs, F. G. Lacour-Gayet, C. Pizarro, K. F. Welke, B. Maruszewski, Z. Tobota, W. J. Miller, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J. Thorac. Cardiovasc. Surg., November 1, 2009; 138(5): 1139 - 1153. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. M. Putman, M. van Gameren, F. J. Meijboom, P. L. de Jong, J. W. Roos-Hesselink, M. Witsenburg, J. J.M. Takkenberg, and A. J.J.C. Bogers Seventeen years of adult congenital heart surgery: a single centre experience Eur. J. Cardiothorac. Surg., July 1, 2009; 36(1): 96 - 104. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. M. DeCampli and R. P. Burke Interinstitutional comparison of risk-adjusted mortality and length of stay in congenital heart surgery. Ann. Thorac. Surg., July 1, 2009; 88(1): 151 - 156. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. F. Welke, S. M. O'Brien, E. D. Peterson, R. M. Ungerleider, M. L. Jacobs, and J. P. Jacobs The complex relationship between pediatric cardiac surgical case volumes and mortality rates in a national clinical database. J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1133 - 1140. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Jacobs, R. J. Cerfolio, and R. M. Sade The Ethics of Transparency: Publication of Cardiothoracic Surgical Outcomes in the Lay Press. Ann. Thorac. Surg., March 1, 2009; 87(3): 679 - 686. [Full Text] [PDF]
|
|
|
|
|
|
K. F. Welke, B. S. Diggs, T. Karamlou, and R. M. Ungerleider Comparison of Pediatric Cardiac Surgical Mortality Rates From National Administrative Data to Contemporary Clinical Standards Ann. Thorac. Surg., January 1, 2009; 87(1): 216 - 223. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Barach, J. K. Johnson, A. Ahmad, C. Galvan, A. Bognar, R. Duncan, J. P. Starr, and E. A. Bacha A prospective observational study of human factors, adverse events, and patient outcomes in surgery for pediatric cardiac disease. J. Thorac. Cardiovasc. Surg., December 1, 2008; 136(6): 1422 - 1428. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Schmitz, B. Esmailzadeh, U. Herberg, N. Lang, R. Sodian, R. Kozlik-Feldmann, A. Welz, and J. Breuer Hybrid procedures can reduce the risk of congenital cardiovascular surgery Eur. J. Cardiothorac. Surg., October 1, 2008; 34(4): 718 - 725. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Sinzobahamvya, M. Boscheinen, H. C. Blaschczok, R. Kallenberg, J. Photiadis, C. Haun, V. Hraska, and B. Asfour Survival and reintervention after neonatal repair of truncus arteriosus with valved conduit Eur. J. Cardiothorac. Surg., October 1, 2008; 34(4): 732 - 737. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Li, G. Zhang, H. Holtby, S. Cai, M. Walsh, C. A. Caldarone, and G. S. Van Arsdell Significant correlation of comprehensive Aristotle score with total cardiac output during the early postoperative period after the Norwood procedure J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 123 - 128. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L T Eskedal, P S Hagemo, E Seem, A Eskild, M Cvancarova, S Seiler, and E Thaulow Impaired weight gain predicts risk of late death after surgery for congenital heart defects Arch. Dis. Child., June 1, 2008; 93(6): 495 - 501. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Miyamoto, N. Sinzobahamvya, J. Photiadis, A. M Brecher, and B. Asfour Survival after Surgery with Cardiopulmonary Bypass in Low Weight Patients Asian Cardiovasc Thorac Ann, April 1, 2008; 16(2): 115 - 119. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. L. Curzon, S. Milford-Beland, J. S. Li, S. M. O'Brien, J. P. Jacobs, M. L. Jacobs, K. F. Welke, A. J. Lodge, E. D. Peterson, and J. Jaggers Cardiac surgery in infants with low birth weight is associated with increased mortality: Analysis of the Society of Thoracic Surgeons Congenital Heart Database J. Thorac. Cardiovasc. Surg., March 1, 2008; 135(3): 546 - 551. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Eggum, T. Ueland, T. E. Mollnes, V. Videm, P. Aukrust, A. E. Fiane, and H. L. Lindberg Effect of Perfusion Temperature on the Inflammatory Response During Pediatric Cardiac Surgery Ann. Thorac. Surg., February 1, 2008; 85(2): 611 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Luo, B. Li, R. Chen, R. Huang, and G. Lin Effect of ischemic postconditioning in adult valve replacement Eur. J. Cardiothorac. Surg., February 1, 2008; 33(2): 203 - 208. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Miyaji, T. Miyamoto, S. Kohira, K. Nakashima, N. Inoue, H. Sato, and K. Ohara Miniaturized cardiopulmonary bypass system in neonates and small infants Interactive CardioVascular and Thoracic Surgery, February 1, 2008; 7(1): 75 - 79. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. O'Brien, J. P. Jacobs, D. R. Clarke, B. Maruszewski, M. L. Jacobs, H. L. Walters III, C. I. Tchervenkov, K. F. Welke, Z. Tobota, G. Stellin, et al. Accuracy of the Aristotle Basic Complexity Score for Classifying the Mortality and Morbidity Potential of Congenital Heart Surgery Operations Ann. Thorac. Surg., December 1, 2007; 84(6): 2027 - 2037. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Jander, M. Tkaczyk, I. Pagowska-Klimek, W. Pietrzykowski, J. Moll, W. Krajewski, and M. Nowicki Continuous veno-venous hemodiafiltration in children after cardiac surgery Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1022 - 1028. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. G. Bazzani and J. P. Marcin Case Volume and Mortality in Pediatric Cardiac Surgery Patients in California, 1998-2003 Circulation, May 22, 2007; 115(20): 2652 - 2659. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. O. Al-Radi, F. E. Harrell Jr, C. A. Caldarone, B. W. McCrindle, J. P. Jacobs, M. G. Williams, G. S. Van Arsdell, and W. G. Williams Case complexity scores in congenital heart surgery: A comparative study of the Aristotle Basic Complexity score and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) system J. Thorac. Cardiovasc. Surg., April 1, 2007; 133(4): 865 - 875. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. L. Vida, H. Berggren, W. J. Brawn, W. Daenen, D. Di Carlo, R. Di Donato, H. L. Lindberg, A. F. Corno, J. Fragata, M. J. Elliott, et al. Risk of Surgery for Congenital Heart Disease in the Adult: A Multicentered European Study Ann. Thorac. Surg., January 1, 2007; 83(1): 161 - 168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Artrip, D. N. Campbell, D. D. Ivy, M. C. Almodovar, K.-C. Chan, M. B. Mitchell, D. R. Clarke, and F. Lacour-Gayet Birth Weight and Complexity Are Significant Factors for the Management of Hypoplastic Left Heart Syndrome. Ann. Thorac. Surg., October 1, 2006; 82(4): 1252 - 1259. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. F. Welke, I. Shen, and R. M. Ungerleider Current assessment of mortality rates in congenital cardiac surgery. Ann. Thorac. Surg., July 1, 2006; 82(1): 164 - 170. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Kang, V. T. Tsang, M. J. Elliott, M. R. de Leval, and T. J. Cole Does the Aristotle Score predict outcome in congenital heart surgery? Eur. J. Cardiothorac. Surg., June 1, 2006; 29(6): 986 - 988. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Lacour-Gayet Editorial comment: The goal is performance evaluation not outcome prediction Eur. J. Cardiothorac. Surg., June 1, 2006; 29(6): 989 - 990. [Full Text] [PDF]
|
|
|
|
|
|
S. P. McGuirk, J. Stickley, M. Griselli, O. F. Stumper, S. J. Laker, D. J. Barron, and W. J. Brawn Risk assessment and early outcome following the Norwood procedure for hypoplastic left heart syndrome Eur. J. Cardiothorac. Surg., May 1, 2006; 29(5): 675 - 681. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Sinzobahamvya, J. Photiadis, D. Kumpikaite, C. Fink, H. C. Blaschczok, A. M. Brecher, and B. Asfour Comprehensive aristotle score: implications for the norwood procedure. Ann. Thorac. Surg., May 1, 2006; 81(5): 1794 - 1800. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Van Arsdell Invited commentary. Ann. Thorac. Surg., May 1, 2006; 81(5): 1800 - 1801. [Full Text] [PDF]
|
|
|
|
|
|
J. Photiadis, B. Asfour, N. Sinzobahamvya, C. Fink, E. Schindler, A.-M. Brecher, and A. E. Urban Improved Hemodynamics and Outcome After Modified Norwood Operation on the Beating Heart Ann. Thorac. Surg., March 1, 2006; 81(3): 976 - 981. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Larsen, J. Pedersen, J. Jacobsen, S. P. Johnsen, O. K. Hansen, and V. Hjortdal The RACHS-1 risk categories reflect mortality and length of stay in a Danish population of children operated for congenital heart disease Eur. J. Cardiothorac. Surg., December 1, 2005; 28(6): 877 - 881. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Jacobs, M. L. Jacobs, B. Maruszewski, F. G. Lacour-Gayet, D. R. Clarke, C. I. Tchervenkov, J. W. Gaynor, T. L. Spray, G. Stellin, M. J. Elliott, et al. Current Status of the European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons Congenital Heart Surgery Database Ann. Thorac. Surg., December 1, 2005; 80(6): 2278 - 2284. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Schlensak Myocardial protection in congenital heart surgery MMCTS, November 29, 2005; 2005(1129): 729. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Lacour-Gayet, J. P. Jacobs, D. R. Clarke, J.W. Gaynor, M. L. Jacobs, R. H. Anderson, M. J. Elliott, B. Maruszewski, P. Vouhe, and C. Mavroudis Performance of surgery for congenital heart disease: Shall we wait a generation or look for different statistics? J. Thorac. Cardiovasc. Surg., July 1, 2005; 130(1): 234 - 235. [Full Text] [PDF]
|
|
|
|
|
|
T. Miyamoto, N. Sinzobahamvya, D. Kumpikaite, B. Asfour, J. Photiadis, A. M. Brecher, and A. E. Urban Repair of Truncus Arteriosus and Aortic Arch Interruption: Outcome Analysis Ann. Thorac. Surg., June 1, 2005; 79(6): 2077 - 2082. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Hilton, J.R. L. Hamilton, N. Vitale, and R. Haaverstad Effects of 'Bristol' on surgical practice in the United Kingdom Interactive CardioVascular and Thoracic Surgery, June 1, 2005; 4(3): 197 - 199. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Jacobs, F. G. Lacour-Gayet, M. L. Jacobs, D. R. Clarke, C. I. Tchervenkov, J. W. Gaynor, T. L. Spray, B. Maruszewski, G. Stellin, J. Gould, et al. Initial Application in The STS Congenital Database of Complexity Adjustment to Evaluate Surgical Case Mix and Results Ann. Thorac. Surg., May 1, 2005; 79(5): 1635 - 1649. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Monro The next challenge--adapting to change Eur. J. Cardiothorac. Surg., December 1, 2004; 26(6): 1063 - 1072. [Full Text] [PDF]
|
|
|
|
|
|
F. Lacour-Gayet Quality evaluation in congenital heart surgery Eur. J. Cardiothorac. Surg., July 1, 2004; 26(1): 1 - 2. [Full Text] [PDF]
|
|
|
|
|
|
J. P. Jacobs, C. Mavroudis, M. L. Jacobs, F. G. Lacour-Gayet, C. I. Tchervenkov, J. W. Gaynor, D. R. Clarke, T. L. Spray, B. Maruszewski, G. Stellin, et al. Lessons learned from the data analysis of the second harvest (1998-2001) of the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database Eur. J. Cardiothorac. Surg., July 1, 2004; 26(1): 18 - 37. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
