Preoperative Risk-assessment Score for Elective Total Aortic Arch Repair: AAORTA Risk Tool.

Objective: Total transverse aortic arch replacement is a complex operation performed to address aortic aneurysm with and without chronic aortic dissection. To predict 90-day survival after this procedure, we created a holistic tool for predicting postoperative mortality in patients who undergo total arch repair (TAR): the Aortic Arch Operation Risk Tool for Assessment (AAORTA) score. Methods: Univariate and multivariate analyses were performed on data from patients ( Results: Of 470 patients who underwent TAR, 65 (13.8%) died within 90 days of repair. The AAORTA score relied on five preoperative variables: heritable thoracic aortic disease, prior coronary artery bypass grafting (CABG), kidney disease, pulmonary disease (restrictive or obstructive), and no history of smoking. Previous CABG was the strongest predictor of 90-day mortality. The AAORTA score had an AUROCC of 0.784, a Brier score of 0.105, and a goodness-of-fit Conclusion: The AAORTA score can accurately stratify 90-day mortality risk in patients who undergo elective TAR, using only five variables easily acquired during standard preoperative evaluation. This score could be used to aid preoperative counseling with patients and families. Prospective multicenter validation will help establish its generalizability.