JTCS KCI
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
 QUICK SEARCH:   [advanced]


     


This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Morgan L. Brown
Hartzell V. Schaff
Maurice E. Sarano
Thoralf M. Sundt
Joseph A. Dearani
Charles J. Mullany
Thomas A. Orszulak
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Brown, M. L.
Right arrow Articles by Orszulak, T. A.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Brown, M. L.
Right arrow Articles by Orszulak, T. A.
Related Collections
Right arrow Valve disease

J Thorac Cardiovasc Surg 2008;136:566-571
© 2008 The American Association for Thoracic Surgery


Cardiopulmonary Support and Physiology

Is the European System for Cardiac Operative Risk Evaluation model valid for estimating the operative risk of patients considered for percutaneous aortic valve replacement?

Morgan L. Brown, MDa, Hartzell V. Schaff, MDa,*, Maurice E. Sarano, MDb, Zhuo Li, MSc, Thoralf M. Sundt, MDa, Joseph A. Dearani, MDa, Charles J. Mullany, MBMSa, Thomas A. Orszulak, MDa

a Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
b Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
c Division of Biostatistics, Mayo Clinic, Rochester, Minn

Received for publication October 4, 2007; accepted for publication October 30, 2007.

* Address for reprints: Hartzell V. Schaff, MD, Mayo Clinic, 200 1st St SW, Rochester MN 55905. (Email: schaff{at}mayo.edu).

Objective: The European System for Cardiac Operative Risk Evaluation has been used to define a particularly high-risk group of patients for aortic valve replacement in whom alternative procedures, such as stent-mounted percutaneous valve procedures, may be appropriate. Our objective was to assess the validity of this risk assessment at a large-volume, tertiary cardiac surgical center.

Methods: From January 1, 2000, to December 30, 2006, a total of 1177 patients underwent isolated aortic valve replacement at the Mayo Clinic. Patient and operative demographics were recorded in a prospective database. Early mortality (≤30 days) was obtained. Additive and logistic European System for Cardiac Operative Risk Evaluations were calculated for each patient.

Results: The mean patient age was 68.0 years (±14.7 years) at the time of surgery, and 36.8% were female. Variables used in the calculation of the European System for Cardiac Operative Risk Evaluation included chronic lung disease (15% of our cohort), extracardiac arteriopathy (13.8%), neurologic dysfunction (0.2%), previous cardiac surgery (23.2%), renal failure (6.5%), active endocarditis (3.1%), recent myocardial infarction (1.1%), unstable angina (0.1%), and severe pulmonary hypertension (6.5%). The ejection fraction was severely reduced (≤30%) in 4.9% of patients and moderately reduced (≤50%) in 12.7% of patients. One percent of patients were in a critical state, and operation was performed urgently in 3.4% of patients. Although mean mortality estimates were 6.9% ± 3.4% (additive European System for Cardiac Operative Risk Evaluation) and 10.9% ± 12.7% (logistic European System for Cardiac Operative Risk Evaluation), actual overall operative mortality in our patients was 2.5%. Additive and logistic European System for Cardiac Operative Risk Evaluations overestimated operative mortality in low, intermediate, and high-risk subgroups by up to 17.8%.

Conclusions: The European System for Cardiac Operative Risk Evaluation should not be used to determine the operability of patients for isolated aortic valve replacement. Elevated European System for Cardiac Operative Risk Evaluations alone do not appropriately define a population for use of a percutaneous aortic valve.



Abbreviations and Acronyms AVR = aortic valve replacement; CABG = coronary artery bypass grafting; EuroSCORE = European System for Cardiac Operative Risk Evaluation





This article has been cited by other articles:


Home page
Eur J Cardiothorac SurgHome page
H. A. Vohra, D. Pousios, R. N. Whistance, M. P. Haw, C. W. Barlow, S. K. Ohri, S. A. Livesey, and G. M. K. Tsang
Aortic valve replacement in patients with previous coronary artery bypass grafting: 10-year experience
Eur J Cardiothorac Surg, December 26, 2011; (2011) ezr212v1.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
J. Basraon, Y. S. Chandrashekhar, R. John, A. Agnihotri, R. Kelly, H. Ward, and S. Adabag
Comparison of Risk Scores to Estimate Perioperative Mortality in Aortic Valve Replacement Surgery
Ann. Thorac. Surg., August 1, 2011; 92(2): 535 - 540.
[Abstract] [Full Text] [PDF]


Home page
Eur J Cardiothorac SurgHome page
S. Nozohoor, J. Sjogren, T. Ivert, P. Hoglund, and J. Nilsson
Validation of a modified EuroSCORE risk stratification model for cardiac surgery: the Swedish experience
Eur J Cardiothorac Surg, July 1, 2011; 40(1): 185 - 191.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
M. Di Eusanio, D. Fortuna, R. De Palma, A. Dell'Amore, M. Lamarra, G. A. Contini, T. Gherli, D. Gabbieri, I. Ghidoni, D. Cristell, et al.
Aortic valve replacement: Results and predictors of mortality from a contemporary series of 2256 patients
J. Thorac. Cardiovasc. Surg., April 1, 2011; 141(4): 940 - 947.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
R. Rosenhek, B. Iung, P. Tornos, M. J. Antunes, B. D. Prendergast, C. M. Otto, A. P. Kappetein, J. Stepinska, J. J. Kaden, C. K. Naber, et al.
ESC Working Group on Valvular Heart Disease Position Paper: assessing the risk of interventions in patients with valvular heart disease
Eur. Heart J., March 15, 2011; (2011) ehr061v1.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
A. W. ElBardissi, P. Shekar, G. S. Couper, and L. H. Cohn
Minimally invasive aortic valve replacement in octogenarian, high-risk, transcatheter aortic valve implantation candidates
J. Thorac. Cardiovasc. Surg., February 1, 2011; 141(2): 328 - 335.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
M. R. Moon
Predictive value of surgical scoring systems in determining operative risk for octogenarians undergoing aortic valve replacement.
J. Thorac. Cardiovasc. Surg., February 1, 2011; 141(2): 335 - 337.
[Full Text] [PDF]


Home page
CirculationHome page
C. Tamburino, D. Capodanno, A. Ramondo, A. S. Petronio, F. Ettori, G. Santoro, S. Klugmann, F. Bedogni, F. Maisano, A. Marzocchi, et al.
Incidence and Predictors of Early and Late Mortality After Transcatheter Aortic Valve Implantation in 663 Patients With Severe Aortic Stenosis
Circulation, January 25, 2011; 123(3): 299 - 308.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
V. H. Thourani, G. Ailawadi, W. Y. Szeto, T. M. Dewey, R. A. Guyton, M. J. Mack, I. L. Kron, P. Kilgo, and J. E. Bavaria
Outcomes of Surgical Aortic Valve Replacement in High-Risk Patients: A Multiinstitutional Study
Ann. Thorac. Surg., January 1, 2011; 91(1): 49 - 56.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
M. A. Clavel, J. G. Webb, J. Rodes-Cabau, J. B. Masson, E. Dumont, R. De Larochelliere, D. Doyle, S. Bergeron, H. Baumgartner, I. G. Burwash, et al.
Comparison Between Transcatheter and Surgical Prosthetic Valve Implantation in Patients With Severe Aortic Stenosis and Reduced Left Ventricular Ejection Fraction
Circulation, November 9, 2010; 122(19): 1928 - 1936.
[Abstract] [Full Text] [PDF]


Home page
HeartHome page
S. W. Grant, M. P. Devbhandari, A. D. Grayson, I. Dimarakis, I. Kadir, D. M. T. Saravanan, R. D. Levy, S. G. Ray, and B. Bridgewater
What is the impact of providing a transcatheter aortic valve implantation service on conventional aortic valve surgical activity: patient risk factors and outcomes in the first 2 years
Heart, October 15, 2010; 96(20): 1633 - 1637.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
E. M. Tuzcu, S. R. Kapadia, and L. G. Svensson
"SOURCE" of Enthusiasm for Transcatheter Aortic Valve Implantation
Circulation, July 6, 2010; 122(1): 8 - 10.
[Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
T. D. Yan, C. Cao, J. Martens-Nielsen, R. Padang, M. Ng, M. P. Vallely, and P. G. Bannon
Transcatheter aortic valve implantation for high-risk patients with severe aortic stenosis: A systematic review
J. Thorac. Cardiovasc. Surg., June 1, 2010; 139(6): 1519 - 1528.
[Abstract] [Full Text] [PDF]


Home page
Interact CardioVasc Thorac SurgHome page
T. R. Wyss, M. Bigler, M. Stalder, L. Englberger, T. Aymard, A. Kadner, and T. P. Carrel
Absence of prosthesis-patient mismatch with the new generation of Edwards stented aortic bioprosthesis
Interact CardioVasc Thorac Surg, June 1, 2010; 10(6): 884 - 888.
[Abstract] [Full Text] [PDF]


Home page
Eur J Cardiothorac SurgHome page
I. Florath, A. Albert, A. Boening, I. C. Ennker, and J. Ennker
Aortic valve replacement in octogenarians: identification of high-risk patients
Eur J Cardiothorac Surg, June 1, 2010; 37(6): 1304 - 1310.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
S. H. Rahimtoola
The Year in Valvular Heart Disease
J. Am. Coll. Cardiol., April 20, 2010; 55(16): 1729 - 1742.
[Full Text] [PDF]


Home page
Interact CardioVasc Thorac SurgHome page
D. Wendt, B. Osswald, M. Thielmann, K. Kayser, P. Tossios, P. Massoudy, M. Kamler, and H. Jakob
The EuroSCORE - still helpful in patients undergoing isolated aortic valve replacement?
Interact CardioVasc Thorac Surg, February 1, 2010; 10(2): 239 - 244.
[Abstract] [Full Text] [PDF]


Home page
Oxford Textbook of Interventional CardiologyHome page
J. G. Webb and F. Nietlispach
Chapter 39 Transcatheter aortic valve replacement
Oxford Textbook of Interventional Cardiology, January 1, 2010; 1(1): med-9780199569083-chapter - med-9780199569083-chapter.
[Abstract] [Full Text]


Home page
Ann. Thorac. Surg.Home page
M. Portoghese
Transcatheter Aortic Valve Therapy Is Not Aortic Valve Replacement
Ann. Thorac. Surg., December 1, 2009; 88(6): 2071 - 2072.
[Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
M. Thielmann, D. Wendt, H. Eggebrecht, P. Kahlert, P. Massoudy, M. Kamler, R. Erbel, H. Jakob, and S. Sack
Transcatheter Aortic Valve Implantation in Patients With Very High Risk for Conventional Aortic Valve Replacement
Ann. Thorac. Surg., November 1, 2009; 88(5): 1468 - 1474.
[Abstract] [Full Text] [PDF]


Home page
Eur J Cardiothorac SurgHome page
E. Manasse
Cooks and recipes
Eur J Cardiothorac Surg, November 1, 2009; 36(5): 787 - 790.
[Full Text] [PDF]


Home page
Eur J Cardiothorac SurgHome page
T. M. Dewey and M. A. Herbert
Editorial comment: Predicting operative risk: a worthy task -- an elusive goal
Eur J Cardiothorac Surg, November 1, 2009; 36(5): 797 - 798.
[Full Text] [PDF]


Home page
Eur J Cardiothorac SurgHome page
J. Nissinen, F. Biancari, J.-O. Wistbacka, P. Loponen, K. Teittinen, P. Tarkiainen, S.-P. Koivisto, and M. Tarkka
Is it possible to improve the accuracy of EuroSCORE?
Eur J Cardiothorac Surg, November 1, 2009; 36(5): 799 - 804.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
D. Wendt, B. R. Osswald, K. Kayser, M. Thielmann, P. Tossios, P. Massoudy, M. Kamler, and H. Jakob
Society of Thoracic Surgeons Score Is Superior to the EuroSCORE Determining Mortality in High Risk Patients Undergoing Isolated Aortic Valve Replacement
Ann. Thorac. Surg., August 1, 2009; 88(2): 468 - 475.
[Abstract] [Full Text] [PDF]


Home page
ESC Textbook of Cardiovascular MedicineHome page
A. Vahanian, B. Iung, L. Pierard, R. Dion, and J. Pepper
CHAPTER 21 Valvular Heart Disease
ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract] [Full Text] [PDF]




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2008 by The American Association for Thoracic Surgery.