Abstract:
BACKGROUND:Operative risk prediction systems (logistic EuroSCORE I, EuroSCORE II and STS Score) are employed together with multidisciplinary discussion to contraindicate conventional surgery in patients with valvular heart disease and propose the employment of alternative transcatheter procedures. The EuroSCORE I has been reported to underperform in these circumstances; we hypothesize that the EuroSCORE II is best suited for the stratification of risk in patients with structural deterioration (SVD) of valvular bioprostheses and potential candidates to the Valve-in-Valve procedure (deployment of a transcatheter valve within a failing valvular bioprosthesis). METHODS AND EVALUATION OF THE HYPOTHESIS:A multi-institutional collaboration is required to fully address such hypothesis. Therefore, we performed a preliminary validation study by retrieval of the complete records of 81 patients undergoing reoperative aortic valve replacement for preoperative diagnosis of bioprosthetic SVD at our Institution. Logistic EuroSCORE I, EuroSCORE II and STS Score were calculated by preoperatively available data. Faced to an observed reoperative mortality of 4.9%, average EuroSCORE I was 15.8%±13.4, EuroSCORE II was 7.3%±7.4 and the STS Score was 15%±9.8. The three systems provided sufficient adequacy (Hosmer-Lemeshow p=0.847, p=0.999 and p=0.9948, respectively). Yet, the area under the ROC curve was significantly higher for the EuroSCORE II (0.9903) vs. the EuroSCORE I (0.8994) (p=0.044). The STS Score yielded an intermediate figure (0.9643). The odds ratios (logistic regression) were 1.079 for EuroSCORE I, 1.223 for the STS Score and 1.474 for EuroSCORE II. CONCLUSIONS:The three investigated algorithms showed reasonable calibration in the prediction of mortality for reoperative aortic valve replacement, but they evenly overestimated the observed mortality. The hypothesis that the EuroSCORE II is better suited for the selection of candidates to Valve-in-Valve implantation is worth of further multi-institutional investigations on the basis of our preliminary findings and due to the expanding role of transcatheter techniques.
journal_name
Med Hypothesesjournal_title
Medical hypothesesauthors
Anselmi A,Ruggieri VG,Harmouche M,Mascle S,Auffret V,Le Breton H,Beneux X,Verhoye JPdoi
10.1016/j.mehy.2015.01.043subject
Has Abstractpub_date
2015-05-01 00:00:00pages
470-3issue
5eissn
0306-9877issn
1532-2777pii
S0306-9877(15)00064-Xjournal_volume
84pub_type
杂志文章abstract::Virulence factors are microbial products that are known to be harmful to the host and may assist in the pathogenesis of the micro-organism. Superantigens, including those produced by bacteria and viruses, clearly act as virulence factors. The clinical effects of superantigens can be not only acute but also chronic and...
journal_title:Medical hypotheses
pub_type: 杂志文章
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abstract::Fissured tongue (FT) is a condition frequently seen in the general population. Clinically, FT is characterized by grooves that vary in depth and are noted along the dorsal and/or dorsolateral aspects of the tongue. Furthermore, FT presents many enlarged, smooth filiform papillae and subepithelial inflammatory infiltra...
journal_title:Medical hypotheses
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journal_title:Medical hypotheses
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journal_title:Medical hypotheses
pub_type: 杂志文章
doi:10.1016/0306-9877(95)90239-2
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journal_title:Medical hypotheses
pub_type: 杂志文章
doi:10.1016/j.mehy.2007.06.041
更新日期:2008-01-01 00:00:00
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journal_title:Medical hypotheses
pub_type: 杂志文章
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更新日期:2018-05-01 00:00:00
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journal_title:Medical hypotheses
pub_type: 杂志文章
doi:10.1016/0306-9877(87)90175-7
更新日期:1987-05-01 00:00:00
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journal_title:Medical hypotheses
pub_type: 历史文章,杂志文章
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更新日期:1998-10-01 00:00:00
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journal_title:Medical hypotheses
pub_type: 杂志文章
doi:10.1016/0306-9877(87)90152-6
更新日期:1987-06-01 00:00:00
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journal_title:Medical hypotheses
pub_type: 社论
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更新日期:2010-05-01 00:00:00
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journal_title:Medical hypotheses
pub_type: 杂志文章
doi:10.1016/j.mehy.2020.110480
更新日期:2021-01-04 00:00:00
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journal_title:Medical hypotheses
pub_type: 杂志文章
doi:10.1016/j.mehy.2006.04.054
更新日期:2007-01-01 00:00:00
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journal_title:Medical hypotheses
pub_type: 杂志文章
doi:10.1016/j.mehy.2011.09.022
更新日期:2011-12-01 00:00:00
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journal_title:Medical hypotheses
pub_type: 杂志文章
doi:10.1016/j.mehy.2008.03.023
更新日期:2008-08-01 00:00:00
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pub_type: 杂志文章,评审
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journal_title:Medical hypotheses
pub_type: 杂志文章
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journal_title:Medical hypotheses
pub_type: 杂志文章
doi:10.1016/j.mehy.2010.03.010
更新日期:2010-09-01 00:00:00
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journal_title:Medical hypotheses
pub_type: 杂志文章
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更新日期:1991-08-01 00:00:00
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journal_title:Medical hypotheses
pub_type: 杂志文章
doi:10.1016/j.mehy.2017.03.029
更新日期:2017-06-01 00:00:00
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journal_title:Medical hypotheses
pub_type: 杂志文章
doi:10.1016/j.mehy.2010.08.047
更新日期:2011-01-01 00:00:00
abstract::To discuss the possible pathogenesis of outlet obstructive constipation (OOC) and identify the theoretical basis of the Procedure for Prolapse and Hemorrhoids (PPH) used to treat outlet obstructive constipation (OOC). 19 patients diagnosed with outlet obstructive constipation (OOC) form the case group, and 9 healthy v...
journal_title:Medical hypotheses
pub_type: 杂志文章
doi:10.1016/j.mehy.2015.03.022
更新日期:2015-07-01 00:00:00
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journal_title:Medical hypotheses
pub_type: 杂志文章
doi:10.1016/0306-9877(86)90078-2
更新日期:1986-03-01 00:00:00
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journal_title:Medical hypotheses
pub_type: 杂志文章
doi:10.1016/0306-9877(87)90135-6
更新日期:1984-07-01 00:00:00
abstract::The etiology of Autism Spectrum Disorders (ASDs) continues to be elusive. While ASDs have been shown to be heritable, several environmental co-factors, such as, e.g. pre- or perinatal adverse events, could play a role in the pathogenesis of the disorder as well. Prevalence of ASDs appears to have increased in the last...
journal_title:Medical hypotheses
pub_type: 杂志文章
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更新日期:2014-06-01 00:00:00