STS Releases New Risk-Prediction Tools for Emerging Surgical Scenarios

The Society of Thoracic Surgeons (STS) has published three new online calculators that spell out personalized risks for mortality and major complications associated with isolated tricuspid valve repair and replacement, surgical aortic valve repair after TAVI, and multivalve surgeries with or without CABG.

The tools are intended for use by surgeons who are counseling patients considering the various surgeries, but also are accessible to patients who wish to use them directly.

“The STS risk calculators cover a large portion of patients undergoing cardiac surgery, but still we were missing a portion of specific and sometimes more nuanced patients,” STS President Jennifer C. Romano, MD (University of Michigan Congenital Heart Center, Ann Arbor), told TCTMD, referring to their existing portfolio of adult cardiac surgery risk calculators to predict operative risk and for specific procedures such as surgical repair of primary mitral regurgitation. “Of the over 10 million patients that we have in our database, our risk calculators have examined the most common types of operations,” she said

Cardiac surgeries have grown more complex in recent years, with patients often needing multiple valves or redo procedures, so having calculators that are able to take all of that into account will be powerful for providers in counseling their patients, Romano added. Compared with sharing with patients the existing literature, these calculators allow providers to use patient-specific factors, a feature that “enables you to be much more specific—because some patients may be quite low risk, other patients may be quite high risk. The calculators give you much more granularity.”

The tricuspid calculator gives operators access to contemporary STS data, drawn from 13,587 patients in the STS Adult Cardiac Surgery Database who underwent isolated tricuspid valve surgery between 2017 and 2023.

Likewise, the growing number of SAVR procedures following TAVI operations spurred the need for its own calculator, according to Romano, especially given the need for device explantation. This tool was based on data from 5,457 patients treated between 2012 and 2023.

Lastly, the multivalve calculator, which was developed based on 32,938 patients treated between 2017 and 2023, covers any surgery involving aortic valve replacement as well as replacement or repair of the mitral valve with and without concomitant CABG.

All three mobile-friendly calculators cleanly display a patient’s risk for the following: operative mortality, morbidity and mortality, stroke, renal failure, reoperation, prolonged ventilation, deep sternal wound infection, long hospital stay (> 14 days), and short hospital stay (< 6 days).

Additionally, Romano pointed out that eventually these calculators, once linked with National Death Index data, will be able to predict not only 30-day risks but also those at 5 and 10 years. “Obviously knowing how you're going to be in 30 days is important for people,” she said, “but they really want to know: ‘How am I going to be doing in the long term?’ As we continue to link the National Death Index with the database, we will continue to update these calculators with the aim of providing estimations of long-term outcomes as well.”

The STS plans to roll out additional risk calculators for patients undergoing aortic valve surgeries like aortic ascending arch procedures as well as for thoracic surgery, including lung cancer operations.

“The calculators are a great example of how our database is really intended to help our members and our patients,” Romano stressed. “This is something that is used day in and day out in the hands of physicians who are guiding care for patients. I think it really shows the value of having built this large database to be able to make sure that people are getting the best care possible.”