The Society of Thoracic Surgeons 2008 Cardiac Surgery Risk Models: Part 2—Isolated Valve Surgery

O’Brien, Sean M.; Shahian, David M.; Filardo, Giovanni; Ferraris, Victor A.; Haan, Constance K.; Rich, Jeffrey B.; Normand, Sharon‐Lise T.; DeLong, Elizabeth R.; Shewan, Cynthia M.; Dokholyan, Rachel S.; Peterson, Eric D.; Edwards, Fred H.; Anderson, Richard P.

doi:10.1016/j.athoracsur.2009.05.056

Cited by 1,115 publications

(722 citation statements)

References 9 publications

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“…So far, there are virtually no prospective randomized trials comparing minimally invasive valve surgery (MIMVS) and standard sternotomy (ST) in an unbiased way, and the majority of evidence rely on observational studies. Moreover, definition of the level of risk has been a controversial issue, mainly because the currently available tools of risk prediction in cardiac surgery such as EuroSCORE II [3] and The Society of Thoracic Surgery Predicted of Risk of Mortality [4] lose calibration and discrimination in the upper boundaries or deciles of surgical risk. Hence, defining where to draw the "red line" above which patients should be considered at high risk remains a challenge and an issue of debate.…”

Section: (Ann Thorac Surg 2015;-:---) ó 2015 By the Society Of Thoracmentioning

confidence: 99%

What Is the Role of Minimally Invasive Mitral Valve Surgery in High-Risk Patients? A Meta-Analysis of Observational Studies

Moscarelli

Fattouch

Casula

et al. 2016

The Annals of Thoracic Surgery

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Background. Minimally invasive valve surgery is related to certain better postoperative outcomes. We aimed to assess the role of minimally invasive mitral valve surgery in high-risk patients.Methods. A systematic literature review identified eight studies of which seven fulfilled criteria for metaanalysis. Outcomes for a total of 1,254 patients (731 were conventional standard sternotomy and 523 were minimally invasive mitral valve surgery) were submitted to meta-analysis using random effects modeling. Heterogeneity and subgroup analysis with quality scoring were assessed. The primary end point was early mortality. Secondary end points were intraoperative and postoperative outcomes and long-term follow-up.Results. Minimally invasive mitral valve surgery conferred comparable early mortality to standard sternotomy (p [ 0.19); it was also associated with a lower number of units of blood transfused (weighted mean difference, L1.93; 95% confidence interval [CI], L3.04

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Section: (Ann Thorac Surg 2015;-:---) ó 2015 By the Society Of Thoracmentioning

confidence: 99%

What Is the Role of Minimally Invasive Mitral Valve Surgery in High-Risk Patients? A Meta-Analysis of Observational Studies

Moscarelli

Fattouch

Casula

et al. 2016

The Annals of Thoracic Surgery

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“…Although surgical replacement with either a bioprosthetic or mechanical valve has been shown to confer a reduction in mortality in patients who survive the perioperative period, perioperative mortality with cardiac surgery in patients with ESRD remains extremely high and limits the surgical options in this patient population 105, 106, 107, 108. According to the Society of Thoracic Surgeons risk model, aortic valve replacement (AVR) in patients with ESRD is associated with significantly high perioperative mortality, with an odds ratio of 2.8 for operative mortality defined as death within the same hospitalization as surgery and within 30 days after discharge 109. Similarly, mitral valve repair is associated with an odds ratio of 4.59 for operative mortality 109.…”

Section: Valvular Disease In Patients With Esrdmentioning

confidence: 99%

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

Bhatti

Galougahi

Paz

et al. 2016

JAHA

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“…Traditionally, surgical aortic valve replacement (SAVR) has been the mainstay of treatment for severe AS, but has been associated with 3.2% to 5.6% perioperative mortality when performed without and with concomitant coronary artery bypass graft surgery (CABG), respectively 3, 4. In high‐risk elderly patients, the risk of mortality approaches 10%, and 1 of 3 of these patients’ experiences a major morbidity 3, 4. A contributing factor to the adverse outcomes observed is that many of the elderly patients considered for SAVR are frail and have multiple chronic conditions 5…”

Section: Introductionmentioning

confidence: 99%

Risk Prediction in Aortic Valve Replacement: Incremental Value of the Preoperative Echocardiogram

Tan

Flynn

Chen‐Tournoux

et al. 2015

JAHA

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BackgroundRisk prediction is a critical step in patient selection for aortic valve replacement (AVR), yet existing risk scores incorporate very few echocardiographic parameters. We sought to evaluate the incremental predictive value of a complete echocardiogram to identify high‐risk surgical candidates before AVR.Methods and ResultsA cohort of patients with severe aortic stenosis undergoing surgical AVR with or without coronary bypass was assembled at 2 tertiary centers. Preoperative echocardiograms were reviewed by independent observers to quantify chamber size/function and valve function. Patient databases were queried to extract clinical data. The cohort consisted of 432 patients with a mean age of 73.5 years and 38.7% females. Multivariable logistic regression revealed 3 echocardiographic predictors of in‐hospital mortality or major morbidity: E/e’ ratio reflective of elevated left ventricular (LV) filling pressure; myocardial performance index reflective of right ventricular (RV) dysfunction; and small LV end‐diastolic cavity size. Addition of these echocardiographic parameters to the STS risk score led to an integrated discrimination improvement of 4.1% (P<0.0001). After a median follow‐up of 2 years, Cox regression revealed 5 echocardiographic predictors of all‐cause mortality: small LV end‐diastolic cavity size; LV mass index; mitral regurgitation grade; right atrial area index; and mean aortic gradient <40 mm Hg.ConclusionsEchocardiographic measures of LV diastolic dysfunction and RV performance add incremental value to the STS risk score and should be integrated in prediction when evaluating the risk of AVR. In addition, findings of small hypertrophied LV cavities and/or low mean aortic gradients confer a higher risk of 2‐year mortality.

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The Society of Thoracic Surgeons 2008 Cardiac Surgery Risk Models: Part 2—Isolated Valve Surgery

Cited by 1,115 publications

References 9 publications

What Is the Role of Minimally Invasive Mitral Valve Surgery in High-Risk Patients? A Meta-Analysis of Observational Studies

What Is the Role of Minimally Invasive Mitral Valve Surgery in High-Risk Patients? A Meta-Analysis of Observational Studies

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

Risk Prediction in Aortic Valve Replacement: Incremental Value of the Preoperative Echocardiogram

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