الفهرس 
Introduction
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Abstract
There are several risk scoring systems have been introduced into the field of congenital cardiac surgery in the last decade. Those include the risk adjustment for congenital heart surgery (RACHS-1) system, Aristotle basic complexity score (ABC score) and recently, the STS-EACTS mortality score and categories.
We applied the 3 classification tools to the Assiut University pediatric cardiothoracic patients to test our results in comparison to other centers. Besides the direct outcome comparison, we looked for correlations between the risk category and both the mortality and morbidity and also the risk factors for different outcomes in our center.
A retrospective descriptive study including All pediatric patients (ages ranging from 0 to 16 years old, excluding preterm babies) who underwent cardiac surgery in Assiut University cardiothoracic department between January 2008 and December 2017.
During the 10-years study period, a total of 1095 congenital cardiac surgical procedures were performed. The majority of procedures were open-heart surgery (77.5%; n = 849). The most frequent open heart procedures were tetralogy of Fallout repair, ventricular septal defect closure and atrial septal defect repair (19.5%, 17.9%, 17.17%, respectively). Average cardiopulmonary bypass time and average aortic cross clamp time were 76.05 ± 40.45 and 49.3 ± 29.9 minutes, respectively. Most of the procedures were stratified into the RACHS-1 levels of 1 and 2 (38.9 % and 51 %, respectively), ABC levels of 1 and 2 (39.3 % and 36.3%, respectively), and STS-EACTS mortality categories of 1 and 2 (66.2% and 24.2%, respectively). Postoperative in-hospital mortality was 5.8%, with increasing mortality rates at the higher levels of the RACHS-1 and the ABC. The mean ABC score was 5.57 ± 2.07, which represents a complexity between ABC levels 1 and 2. Likewise, the mean STS-EACTS mortality score was 0.375 ± 0.376 which again placed our complexity of procedures into categories 1 – 2. These scores imply a procedural-based level of complexity in the institute, which would be useful information for a longitudinal study. The most common events were cardiac arrhythmia events, which required medical intervention, temporary pacing or electrical cardioversion (29.4%), and postoperative pyrexia & chest infections (9.1%). Multivariate analysis identified cardiopulmonary bypass time, cross clamp time, RACHS-1 category, ABC levels, STS-EACTS mortality categories as risk factors for prolonged postoperative hospital stay (P – values < 0.05).
The RACHS-1, ABC, and STS-EACTS mortality scoring systems are useful tools for assessing mortality discharge in a medium volume cardiac center in Egypt. The overall postoperative in-hospital mortality rate was found to be 5.6 %. The important risk factors for postoperative mortality were younger age, smaller weight, higher RACHS-1 levels, higher ABC levels, higher STS-EACTS mortality categories, longer bypass time, and longer cross clamp time. The most common complications were serious cardiac arrythemias and postoperative fever. An aggregated database over a longer time may suggest trends that can be used to improve the subsets. Moreover, the inter-institutional case-mix will reveal overall outcomes for nation-wide improvements in quality of care for these patients.