PEACH: A Validated Risk Assessment Score for Adults Undergoing Congenital Heart Disease Surgery

Close up of the hands with stent
A new formula for predicting mortality after cardiac surgery for adults with congenital heart defects, either newly discovered or needing revision, helps physicians weigh the risks vs benefits and improve informed consent and decision making.

For patients with adult congenital heart disease (ACHD) undergoing surgery, the newly developed Perioperative ACHD (PEACH) score was simple and effective for evaluating mortality risk. These findings were published in the Journal of the American College of Cardiology.

Patients (n=1782) undergoing surgery at the Royal Brompton Hospital in the UK between 2003 and 2019 were retrospectively evaluated to develop this risk score for mortality. Data from a cohort of patients (n=975) undergoing surgery for ACHD at the IRCCS Policlinico San Donato in Italy between 2003 and 2015 were used to validate the score.

Patients in the development cohort had a mean age of 35.6±14.4 years and 55.0% were men. Significantly more nonsurvivors were female (n=31; P =.04); had more complex CHD (P =.05); and had higher New York Heart Association (NYHA) functional class (P <.0001), Adult Congenital Heart Surgery (ACHS) score (P =.0005), estimated glomerular filtration rate (eGFR; P =.0002), and systolic pulmonary artery pressure (P =.0009); had lower hemoglobin levels (P =.01); had more had active endocarditis (P =.006); were critical before surgery (P <.0001); and underwent urgent surgery (P <.0001).

In-hospital mortality was associated with 13 clinical and demographic features, particularly NYHA functional class III or IV (odds ratio [OR], 26.9; 95% CI, 10.8-81.5; P <.0001), critical preoperative status (OR, 20.6; 95% CI, 4.4-73.6; P <.0001), and hemoglobin less than 100 or greater than 200 g/L (OR, 11.4; 95% CI, 4-28.3; P <.0001).

On the basis of these associations, the PEACH score comprised 7 features, in which patients were given 1 point if they were NYHA functional class III/IV, underwent urgent surgery, had eGFR of less than 60 mL/min/1.73 m2, had active endocarditis, had at least 2 previous sternotomies, had an ACHS score of 1.6 to 3.0, and a hemoglobin level less than 100 or more than 200 g/L.

Patients with a score of 0 had low risk (n=1224), those with 1 or 2 points had intermediate risk (n=496), and those with 3 or more points had high risk (n=64). Mortality rates for the low-, intermediate-, and high-risk cohorts were 1.0%, 4.7%, and 22.7%, respectively.

For the development cohort, the PEACH score had an area under the receiver operating characteristic curve (AUC) of 0.88 (95% CI, 0.822-0.938), which was a better fit than the ACHS score (AUC, 0.69; 95% CI, 0.60-0.78; P =.0002).

For the validation cohort, the PEACH score had an AUC of 0.75 (95% CI, 0.72-0.77).

This study was limited by determining risk factors using bivariate rather than multivariate analyses.

These data indicated the PEACH score may be useful for evaluating mortality risk prior to surgery among patients with ACHD.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Constantine A, Costola G, Bianchi P, et al. Enhanced assessment of perioperative mortality risk in adults with congenital heart disease. J Am Coll Cardiol. 2021;78(3):234-242. doi:10.1016/j.jacc.2021.04.096