OBJECTIVES: To compare and validate the new European System for Cardiac Operative Risk Evaluation (EuroSCORE) II with EuroSCORE at our institution. METHODS: The logistic EuroSCORE and EuroSCORE II were calculated on the entire patient cohort undergoing major cardiac surgery at our centre between January 2005 and December 2010. The goodness of fit was compared by means of the Hosmer-Lemeshow (HL) chi-squared test and the area under the curve (AUC) of the receiver operating characteristic curves of both scales applied to the same sample of patients. These analyses were repeated and stratified by the type of surgery. RESULTS: Mortality of 5.66% was observed, with estimated mortalities according to logistic EuroSCORE and EuroSCORE II of 9 and 4.46%, respectively. The AUC for EuroSCORE (0.82, 95% confidence interval [CI] 0.79-0.85) was lower than that for EuroSCORE II (0.85, 95% CI 0.83-0.87) without the differences being statistically significant (P = 0.056). Both scales showed a good discriminative capacity for all the pathologies subgroups. The two scales showed poor calibration in the sample: EuroSCORE (χ 2 = 39.3, P HL < 0.001) and EuroSCORE II (χ 2 = 86.69, P HL < 0.001). The calibration of EuroSCORE was poor in the groups of patients undergoing coronary (P HL = 0.01), valve (P HL = 0.01) and combined coronary valve surgery (P HL = 0.012); and that of EuroSCORE II in the group of coronary (P HL = 0.001) and valve surgery (P HL < 0.001) patients. CONCLUSIONS: EuroSCORE II demonstrated good discriminative capacity and poor calibration in the patients undergoing major cardiac surgery at our centre.

OBJECTIVES Carpentier Perimount Magna EaseTM (CPME), Crown PRTTM, and TrifectaTM bovine pericardial valves have been widely used worldwide. The primary end-point was to compare the haemodynamic performance quantified by in vivo echocardiogram of these 3 aortic prostheses. METHODS The “BEST-VALVE” (Comparison of 3 contemporary cardiac bioprosthesis: mid-term valve haemodynamic performance) was a single center randomized clinical trial to compare the haemodynamic and clinical outcomes of the aforementioned bioprostheses. 5 year results are assessed in this manuscript. RESULTS 154 patients were included. CPMETM (n = 48, 31.2%), Crown PRTTM (n = 51, 32.1%) and TrifectaTM (n = 55, 35.7%). Significant differences were observed between the three bioprostheses 5-years after the procedure. These haemodynamic differences were found between CPMETM and Crown PRTTM bioprostheses (Mean aortic gradient: 12.3 mmHg (IQR 7.8–17.5) for CPMETM vs 15 mmHg (IQR 10.8 - 31.9) for Crown PRTTM, p &lt; 0.001) and between CPMETM and TrifectaTM prostheses (Mean aortic gradient: 12.3 mmHg (IQR 7.8–17.5) for CPMETM vs 14.7 mmHg (IQR 8.2–55) for TrifectaTM, p &lt; 0.001), with a better haemodynamic performance of CPMETM. The cumulative incidence of severe structural valve degeneration was 9.5% in the TrifectaTM group at 6 years of follow-up. The 1-, 3- and 5-years survival from all-cause mortality was 91.5%, 83.5% and 74.8%, respectively (Log Rank p = 0.440). Survival from the composite event at 1-, 3- and 5-years follow-up was 92.8%, 74.6% and 59%, respectively (Log Rank p = 0.299). CONCLUSIONS We detected significant differences between the three bioprosthesis having CPMETM the best haemodynamic performance at 5 years follow-up. Clinical registration number EudraTC (European Database of Clinical Trials): 2018-001658-87. https://eudract.ema.europa.eu

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