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.


CONCLUSIONS
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 high-risk patients because the EuroSCORE greatly overestimates their surgical risk.
Department of Cardiovascular Surgery, Charité Hospital, Medical University, Berlin, Germany. sebastian.holinski@charite
Sebastian
S
Holinski
Benjamin
B
Claus
Torsten
T
Christ
Ruta
R
Kasperiunaite
Wolfgang
W
Konertz
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D015607:Stents / Q000706:statistics & numerical data; D016019:Survival Analysis; D015996:Survival Rate