Is the new euroscore II a better predictor for transapical aortic valve implantation?

Martin Haensig, David Michael Holzhey, Michael Andrew Borger, Gerhard Schuler, William Shi, Sreekumar - Subramanian, Ardawan Julian Rastan, Friedrich Wilhelm Mohr

Research output: Contribution to journalArticle

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Abstract

Objectives: Conventional surgical risk scores are used to identify suitable candidates for transapical aortic valve implantation (TA-AVI) at present. However, these scores do not consider multiple high-risk conditions, including porcelain aorta, mediastinal irradiation or frailty. The aim of this study was to compare the predictive ability of the new EuroSCORE II with the surgical risk scores currently in use. Methods: From February 2006 to May 2011, 360 consecutive high-risk patients, age 81.6 μ 6.4 years, 64.4% female, were included using the Edwards SAPIEN™ prosthesis. The prognostic value of the EuroSCORE II was evaluated and compared with the logistic EuroSCORE and STS mortality score by receiver operating characteristics (ROC) curve analysis. In addition, a Spearman correlation analysis was performed, and a stepwise multivariate Cox regression used to identify the independent risk factors of mortality. Results: The STS score and EuroSCORE II (r = 0.504, P < 0.001) showed a good correlation, while a strong correlation was found between the logistic EuroSCORE and EuroSCORE II (r = 0.717, P < 0.001). Thirty-day and in-hospital mortality rates were 10.6% (38 of 360) and 11.4% (41 of 360), respectively. In-hospital mortality rate was estimated by the logistic EuroSCORE: 30.0 μ 15.7%, the STS score: 11.7 μ 7.8% and the EuroSCORE II: 6.7 μ 5.1%. The prognostic values of the STS score, logistic EuroSCORE and the recent EuroSCORE II systems were analysed by ROC curve analysis for the prediction of 30-day (area under the curve, AUC: 0.64 vs 0.55 vs 0.50) and in-hospital mortality (AUC: 0.65 vs 0.54 vs 0.49). Multivariate regression analysis revealed length of preoperative hospital stay >5 days, body weight <65 kg, preoperative aortic annular diameter =20 mm, vital capacity <70% and concomitant mitral regurgitation >1+ as independent risk factors. Conclusion: In patients undergoing TA-AVI, the new EuroSCORE II correlates strongly with the logistic EuroSCORE, but is a poorer predictor of 30-day and in-hospital mortality than the STS score. A true transcatheter aortic valve implantation risk score would be desirable beyond the established scores.

Original languageEnglish (US)
Pages (from-to)302-308
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume44
Issue number2
DOIs
StatePublished - Jul 2013

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Aortic Valve
Dental Porcelain
Mortality
Hospital Mortality
ROC Curve
Prostheses and Implants
Aorta
Body Weight

Keywords

  • Aortic valve implantation
  • Euroscore
  • Minimally invasive
  • Transapical

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Is the new euroscore II a better predictor for transapical aortic valve implantation? / Haensig, Martin; Holzhey, David Michael; Borger, Michael Andrew; Schuler, Gerhard; Shi, William; Subramanian, Sreekumar -; Rastan, Ardawan Julian; Mohr, Friedrich Wilhelm.

In: European Journal of Cardio-thoracic Surgery, Vol. 44, No. 2, 07.2013, p. 302-308.

Research output: Contribution to journalArticle

Haensig, M, Holzhey, DM, Borger, MA, Schuler, G, Shi, W, Subramanian, S, Rastan, AJ & Mohr, FW 2013, 'Is the new euroscore II a better predictor for transapical aortic valve implantation?', European Journal of Cardio-thoracic Surgery, vol. 44, no. 2, pp. 302-308. https://doi.org/10.1093/ejcts/ezt038
Haensig, Martin ; Holzhey, David Michael ; Borger, Michael Andrew ; Schuler, Gerhard ; Shi, William ; Subramanian, Sreekumar - ; Rastan, Ardawan Julian ; Mohr, Friedrich Wilhelm. / Is the new euroscore II a better predictor for transapical aortic valve implantation?. In: European Journal of Cardio-thoracic Surgery. 2013 ; Vol. 44, No. 2. pp. 302-308.
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title = "Is the new euroscore II a better predictor for transapical aortic valve implantation?",
abstract = "Objectives: Conventional surgical risk scores are used to identify suitable candidates for transapical aortic valve implantation (TA-AVI) at present. However, these scores do not consider multiple high-risk conditions, including porcelain aorta, mediastinal irradiation or frailty. The aim of this study was to compare the predictive ability of the new EuroSCORE II with the surgical risk scores currently in use. Methods: From February 2006 to May 2011, 360 consecutive high-risk patients, age 81.6 μ 6.4 years, 64.4{\%} female, were included using the Edwards SAPIEN™ prosthesis. The prognostic value of the EuroSCORE II was evaluated and compared with the logistic EuroSCORE and STS mortality score by receiver operating characteristics (ROC) curve analysis. In addition, a Spearman correlation analysis was performed, and a stepwise multivariate Cox regression used to identify the independent risk factors of mortality. Results: The STS score and EuroSCORE II (r = 0.504, P < 0.001) showed a good correlation, while a strong correlation was found between the logistic EuroSCORE and EuroSCORE II (r = 0.717, P < 0.001). Thirty-day and in-hospital mortality rates were 10.6{\%} (38 of 360) and 11.4{\%} (41 of 360), respectively. In-hospital mortality rate was estimated by the logistic EuroSCORE: 30.0 μ 15.7{\%}, the STS score: 11.7 μ 7.8{\%} and the EuroSCORE II: 6.7 μ 5.1{\%}. The prognostic values of the STS score, logistic EuroSCORE and the recent EuroSCORE II systems were analysed by ROC curve analysis for the prediction of 30-day (area under the curve, AUC: 0.64 vs 0.55 vs 0.50) and in-hospital mortality (AUC: 0.65 vs 0.54 vs 0.49). Multivariate regression analysis revealed length of preoperative hospital stay >5 days, body weight <65 kg, preoperative aortic annular diameter =20 mm, vital capacity <70{\%} and concomitant mitral regurgitation >1+ as independent risk factors. Conclusion: In patients undergoing TA-AVI, the new EuroSCORE II correlates strongly with the logistic EuroSCORE, but is a poorer predictor of 30-day and in-hospital mortality than the STS score. A true transcatheter aortic valve implantation risk score would be desirable beyond the established scores.",
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AU - Holzhey, David Michael

AU - Borger, Michael Andrew

AU - Schuler, Gerhard

AU - Shi, William

AU - Subramanian, Sreekumar -

AU - Rastan, Ardawan Julian

AU - Mohr, Friedrich Wilhelm

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N2 - Objectives: Conventional surgical risk scores are used to identify suitable candidates for transapical aortic valve implantation (TA-AVI) at present. However, these scores do not consider multiple high-risk conditions, including porcelain aorta, mediastinal irradiation or frailty. The aim of this study was to compare the predictive ability of the new EuroSCORE II with the surgical risk scores currently in use. Methods: From February 2006 to May 2011, 360 consecutive high-risk patients, age 81.6 μ 6.4 years, 64.4% female, were included using the Edwards SAPIEN™ prosthesis. The prognostic value of the EuroSCORE II was evaluated and compared with the logistic EuroSCORE and STS mortality score by receiver operating characteristics (ROC) curve analysis. In addition, a Spearman correlation analysis was performed, and a stepwise multivariate Cox regression used to identify the independent risk factors of mortality. Results: The STS score and EuroSCORE II (r = 0.504, P < 0.001) showed a good correlation, while a strong correlation was found between the logistic EuroSCORE and EuroSCORE II (r = 0.717, P < 0.001). Thirty-day and in-hospital mortality rates were 10.6% (38 of 360) and 11.4% (41 of 360), respectively. In-hospital mortality rate was estimated by the logistic EuroSCORE: 30.0 μ 15.7%, the STS score: 11.7 μ 7.8% and the EuroSCORE II: 6.7 μ 5.1%. The prognostic values of the STS score, logistic EuroSCORE and the recent EuroSCORE II systems were analysed by ROC curve analysis for the prediction of 30-day (area under the curve, AUC: 0.64 vs 0.55 vs 0.50) and in-hospital mortality (AUC: 0.65 vs 0.54 vs 0.49). Multivariate regression analysis revealed length of preoperative hospital stay >5 days, body weight <65 kg, preoperative aortic annular diameter =20 mm, vital capacity <70% and concomitant mitral regurgitation >1+ as independent risk factors. Conclusion: In patients undergoing TA-AVI, the new EuroSCORE II correlates strongly with the logistic EuroSCORE, but is a poorer predictor of 30-day and in-hospital mortality than the STS score. A true transcatheter aortic valve implantation risk score would be desirable beyond the established scores.

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