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

Abstract 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. Univariate and multivariate analyses were performed on data from patients (N=470; 243 with nondissecting aneurysm, 227 with chronic Type A dissection) who underwent TAR at a high-volume practice between April 2006 and November 2024. Regression analysis identified variables to be used in the AAORTA score. The predictive performance of the score was assessed with the area under the receiver operating characteristic curve (AUROCC), Brier score, and linear fitting. 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 R 2 of 0.954. 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.