Overestimation of the Operative Risk by the EuroSCORE Also in High-Risk Patients Undergoing Aortic Valve Replacement with a Stentless Biological Prosthesis
Background: The EuroSCORE generally overestimates the risk of standard aortic valve replacement (AVR). The predictive value of this risk algorithm for high-risk patients undergoing stentless AVR is unclear; therefore, we compared the EuroSCORE prediction with our results in this patient population.
Methods: One hundred thirty-two patients with a logistic EuroSCORE of at least 10 (mean, 25) underwent primary isolated AVR with a stentless bioprosthesis between January 2004 and December 2007. Seventy-one patients (54%) were octogenarians or nonagenarians, 62 (47%) had a reduced left ventricular ejection fraction, and 46 (35%) had an extracardiac arteriopathy.
Results: Maximum/mean pressure gradients for the implanted valve prostheses were 19/11 mm Hg, and the mean regurgitation grade was 0.06. Stroke occurred in 3% of the patients, and a permanent pacemaker was required in 3%. The 30-day mortality rate was 8%. Another 5% of the patients died after the 30th postoperative day but within the same hospital admission. The predicted mortality was almost 100% greater than the observed mortality.
Conclusion: We observed a mortality rate that was 50% lower than that predicted by the logistic EuroSCORE. Therefore, one should not hesitate to use stentless valves in highrisk patients because the EuroSCORE greatly overestimates their surgical risk.
Bonow RO, Carabello B, de Leon AC Jr, et al. 1998. Guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). Circulation 98:1949-84.nBorger MA, Carson SM, Ivanov J, et al. 2005. Stentless aortic valves are hemodynamically superior to stented valves during mid-term follow-up: a large retrospective study. Ann Thorac Surg 80:2180-5.nCribier A, Eltchaninoff H, Tron C, et al. 2006. Treatment of calcific aortic stenosis with the percutaneous heart valve: mid-term follow up from the initial feasibility study. J Am Coll Cardiol 47:1214-23.nDewey TM, Brown D, Ryan WH, Herbert MA, Prince SL, Mack MJ. 2008. Reliability of risk algorithms in predicting early and late operative outcomes in high-risk patients undergoing aortic valve replacement. J Thorac Cardiovasc Surg 135:180-7.nGammie JS, Brown JW, Brown JM, et al. 2006. Aortic valve bypass for the high-risk patient with aortic stenosis. Ann Thorac Surg 81:1605-10.nGeissler HJ, Hölzl P, Marohl S, et al. 2000. Risk stratification in heart surgery: comparison of six score systems. Eur J Cardiothorac Surg 17:400-6.nGrossi EA, Schwartz CF, Yu PJ, et al. 2008. High-risk aortic valve replacement: Are the outcomes as bad as predicted? Ann Thorac Surg 85:102-7.nHarken DE, Soroff HS, Taylor WJ, Lefemine AA, Gupta SK, Lunzer S. 1960. Partial and complete prostheses in aortic insufficiency. J Thorac Cardiovasc Surg 40:744-62.nLieberman EB, Bashore TM, Hermiller JB, et al. 1995. Balloon aortic valvuloplasty in adults: failure of procedure to improve long-term survival. J Am Coll Cardiol 26:1522-8.nMarcheix B, Lemarche Y, Berry C, et al. 2007. Surgical aspects of endovascular retrograde implantation of the aortic CoreValve bioprosthesis in high-risk older patients with severe symptomatic aortic stenosis. J Thorac Cardiovasc Surg 134:1150-6.nRoques F, Nashef SAM, Michel P, et al. 1999. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 15:816-23.nWalther T, Falk V, Kempfert J, et al. 2008. Transapical minimally invasive aortic valve implantation; the initial 50 patients. Eur J Cardiothorac Surg 33:983-8.nYe J, Cheung A, Lichtenstein SV, et al. 2007. Six-month outcome of transapical transcatheter aortic valve implantation in the initial seven patients. Eur J Cardiothorac Surg 31:16-21.n
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).