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Is the Euroscore II Suited to Predict Mortality after Surgical Aortic Valve Replacement in Octogenarians?

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OBJECTIVE: Since 2011, the Euroscore II is available and can be used to predict mortality after cardiac surgery. The aim of this study was to assess the current hospital mortality rates and to validate this score in a large monocentric cohort of octogenarian patients operated for aortic valve replacement (AVR).

 METHODS: Between January 2002 and December 2014, 1240 consecutives octogenarian patients (573 females/ 667 males) with a mean age of 82.6±2.3 years [80-94] underwent surgical isolated AVR (n=769 – 62.0%) or combined procedure (AVR + Coronary Artery Bypass Grafting CABG: n=471 – 38.0%) in the same center. Global mean Log Euroscore and Euroscore II were respectively 10.5±6.5% [5.5%-67.9%] and 3.4±4.0% [0.9%-51.4%].

 RESULTS: The hospital mortality rate was 2.3% (n=28). Median ICU stay was 2 days [Min-Max: 0-60] for a median hospital length of stay of 12 days [Min-Max: 6-112]. In multivariate analysis, the independent risk factors for hospital mortality were preoperative cardiogenic shock (OR=12.60; 95%CI [3.71-37.21]) and cardiopulmonary bypass time (OR=1.02; 95%CI [1.01-1.03]). Associated bypass grafting was not associated with a significant increase of mortality (hospital mortality of 2.0% (n=15) and 2.8% (n=13) for isolated and combined AVR respectively). Neither the Logistic Euroscore nor the new Euroscore II were correlated with mortality, with poor discriminative powers (Areas under the ROC curve of 0.60 95%CI [0.57-0.62] and 0.58 95%CI [0.55-0.61] respectively).

 CONCLUSIONS: Isolated AVR in octogenarians is currently safe and associated with a very low mortality rate. Associated CABG can safely be performed in selected octogenarian patients. Although closer to the observed mortality, the new Euroscore II does not allow to predict the individual risk of death of octogenarian patients requiring AVR.

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