title: EuroScore 2 for identification of patients for transapical aortic valve replacement--a single center retrospective in 206 patients.
abstract: BACKGROUND
  Operative risk scoring algorithms identify patients with severe AS for transcatheter valve implantation in whom the anticipated operative mortality for conventional surgery would be considered prohibitive. We compared the three risk scores EuroScore 1 (LES), society of thoracic surgeons' (STS) score and ACEF (age-creatinine-ejection fraction score) to the readjusted EuroScore 2 recently presented.
  
  
  METHODS
  We reviewed all consecutive patients receiving either isolated conventional aortic valve replacement (cAVR) or transapical aortic valve implantation (TA-TAVI) in a two-year period (n = 206). 30-days mortality was considered as primary endpoint.
  
  
  RESULTS
  TA-TAVI was performed in 76 patients, isolated cAVR in 130 patients. Overall mortality was 4.4% (TA-TAVI: 7.9%; cAVR: 2.3%). EuroScore 2 showed a good estimation for the entire population as well as within the subgroups: 4,02 ± 5,36% (TA-TAVI: 6.16 ± 7.14%, cAVR: 2.77 ± 3.42%). Predicted mortalities as assessed by LES were largely overestimated (TA-TAVI: 27.4 ± 20.9% cAVR: 10.6 ± 10.6%, sensitivity: 0.89, specificity: 0.71). STS predicted mortality was 6.3 ± 4.4% for TA-TAVI patients as to 3.2 ± 3.1% for cAVR patients (sens.: 0.22, spec.: 0.96) and ACEF predicted a mortality of 1.16 ± 0.36% for cAVR and 1.58 ± 0.59% for TA-TAVI patients (sens.: 0.78, spec.: 0.89).
  
  
  CONCLUSIONS
  The newly refined EuroScore 2 showed a good correlation within the studied population. For the individual patient, new cut-offs will have to be defined to triage patients for TAVI procedure. A drawback for complex score systems such as EuroScore and STS is the lack of recalibration to smaller populations as encountered in even large single centers.
authors.affiliation: Clinic for Cardiothoracic and Vascular Surgery, University Clinic RWTH Aachen, Aachen, Germany. agoetzenich@ukaachen.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Goetzenich
authors.forename: Imke
authors.initials: I
authors.lastname: Deppe
authors.forename: Heike
authors.initials: H
authors.lastname: Schnöring
authors.forename: George L
authors.initials: GL
authors.lastname: Gafencu
authors.forename: Dumitrita-Alina
authors.initials: DA
authors.lastname: Gafencu
authors.forename: Hülya
authors.initials: H
authors.lastname: Yildirim
authors.forename: Lachmandath
authors.initials: L
authors.lastname: Tewarie
authors.forename: Jan
authors.initials: J
authors.lastname: Spillner
authors.forename: Ajay
authors.initials: A
authors.lastname: Moza
mesh_terms: D000465:Algorithms; D000704:Analysis of Variance; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D015233:Models, Statistical; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity