title: Logistic EuroSCORE I risk analysis in aortic valve reoperations after bioprosthetic replacement.
abstract: OBJECTIVE
  The aim was to evaluate the early and long-term results of redo-aortic valve replacement (AVR) for dysfunctioning bioprostheses, according to the type of bioprosthesis failure. The performance of the EuroSCORE in predicting operative mortality was addressed.
  
  
  METHODS
  A retrospective analysis was performed of 164 patients who had undergone redo-AVR at the authors' institution. All data were collected prospectively. The type of bioprosthesis failure was categorized as either structural valve dysfunction (SVD), non-structural vale dysfunction (NSVD), or infective endocarditis (IE). The logistic EuroSCORE I was obtained, and a formal analysis of its predictive performance was conducted.
  
  
  RESULTS
  The mean logistic EuroSCORE was 26.3 +/- 20.6%, while the observed operative mortality was 10.6%. The EuroSCORE overestimated mortality in all subgroups of indication; operative mortality was higher among the NSVD (14.7%) and IE (13.9%) groups, and lower among SVD patients (8.5%). The performance of the EuroSCORE in predicting mortality was better in SVD patients, and worse in NSVD patients (areas under the ROC curve of 0.857 and 0.751, respectively). Only patient-related factors independently predicted the operative mortality (logistic regression). The SVD patients displayed a significantly better long-term survival compared to NSVD and IE patients. Patient-related factors were seen to be the determinants of long-term survival.
  
  
  CONCLUSIONS
  Redo-AVR can be performed with good early and long-term results, despite a high predicted risk. The logistic EuroSCORE I globally overestimates the risk, and its performance varies considerably according to the indication for redo-AVR. Therefore, it should not be used to determine the application of valve-in-valve procedures. The type of indication for redo-AVR (SVD, NSVD, IE) defines three different profiles of patients having distinctive early and long-term behaviors.
authors.affiliation: Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. gianvito_ruggieri@libero.it
authors.forename: Vito Giovanni
authors.initials: VG
authors.lastname: Ruggieri
authors.forename: Nezha Roudmane
authors.initials: NR
authors.lastname: Lenglet
authors.forename: Amedeo
authors.initials: A
authors.lastname: Anselmi
authors.forename: Erwan
authors.initials: E
authors.lastname: Fletcher
authors.forename: Majid
authors.initials: M
authors.lastname: Harmouche
authors.forename: Anne
authors.initials: A
authors.lastname: Ingels
authors.forename: Hervé
authors.initials: H
authors.lastname: Corbineau
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Verhoye
authors.forename: Thierry
authors.initials: T
authors.lastname: Langanay
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery; D001705:Bioprosthesis / Q000009:adverse effects; D015897:Comorbidity; D019544:Equipment Failure Analysis / Q000379:methods; D005260:Female; D005602:France; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D018579:Patient Selection; D011475:Prosthesis Failure; D012372:ROC Curve; D012086:Reoperation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome