Relationship between the logistic EuroSCORE and the Society of Thoracic Surgeons Predicted Risk of Mortality score in patients implanted with the CoreValve ReValving System—A Bern-Rotterdam Study

2010 ◽  
Vol 159 (2) ◽  
pp. 323-329 ◽  
Author(s):  
Nicolo Piazza ◽  
Peter Wenaweser ◽  
Menno van Gameren ◽  
Thomas Pilgrim ◽  
Apostolos Tsikas ◽  
...  
Keyword(s):  
Rotterdam Study ◽  
Logistic Euroscore ◽  
System A ◽  
Risk Of Mortality ◽  
Predicted Risk

scholarly journals Surgical Explantation of Transcatheter Aortic Valve Bioprostheses

2021 ◽  
Vol 14 (4) ◽  
Author(s):  
Alexander A. Brescia ◽  
G. Michael Deeb ◽  
Stephane Leung Wai Sang ◽  
Daizo Tanaka ◽  
P. Michael Grossman ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Paravalvular Leak ◽  
Transcatheter Aortic Valve ◽  
Risk Of Mortality ◽  
Risk Patients ◽  
Transcatheter Valve ◽  
Predicted Risk

Background: Despite the rapid adoption of transcatheter aortic valve replacement (TAVR) since its initial approval in 2011, the frequency and outcomes of surgical explantation of TAVR devices (TAVR-explant) is poorly understood. Methods: Patients undergoing TAVR-explant between January 2012 and June 2020 at 33 hospitals in Michigan were identified in the Society of Thoracic Surgeons Database and linked to index TAVR data from the Transcatheter Valve Therapy Registry through a statewide quality collaborative. The primary outcome was operative mortality. Indications for TAVR-explant, contraindications to redo TAVR, operative data, and outcomes were collected from Society of Thoracic Surgeons and Transcatheter Valve Therapy databases. Baseline Society of Thoracic Surgeons Predicted Risk of Mortality was compared between index TAVR and TAVR-explant. Results: Twenty-four surgeons at 12 hospitals performed TAVR-explants in 46 patients (median age, 73). The frequency of TAVR-explant was 0.4%, and the number of explants increased annually. Median time to TAVR-explant was 139 days and among known device types explanted, most were self-expanding valves (29/41, 71%). Common indications for TAVR-explant were procedure-related failure (35%), paravalvular leak (28%), and need for other cardiac surgery (26%). Contraindications to redo TAVR included need for other cardiac surgery (28%), unsuitable noncoronary anatomy (13%), coronary obstruction (11%), and endocarditis (11%). Overall, 65% (30/46) of patients underwent concomitant procedures, including aortic repair/replacement in 33% (n=15), mitral surgery in 22% (n=10), and coronary artery bypass grafting in 16% (n=7). The median Society of Thoracic Surgeons Predicted Risk of Mortality was 4.2% at index TAVR and 9.3% at TAVR-explant ( P =0.001). Operative mortality was 20% (9/46) and 76% (35/46) of patients had in-hospital complications. Of patients alive at discharge, 37% (17/37) were discharged home and overall 3-month survival was 73±14%. Conclusions: TAVR-explant is rare but increasing, and its clinical impact is substantial. As the utilization of TAVR expands into younger and lower-risk patients, providers should consider the potential for future TAVR-explant during selection of an initial valve strategy.

scholarly journals OUTCOMES IN THE COREVALVE US HIGH-RISK PIVOTAL TRIAL IN PATIENTS WITH A SOCIETY OF THORACIC SURGEONS PREDICTED RISK OF MORTALITY LESS THAN OR EQUAL TO 7

2016 ◽  
Vol 67 (13) ◽  
pp. 121
Author(s):  
Michael J. Reardon ◽  
David Adams ◽  
Neal Kleiman ◽  
G. Michael Deeb ◽  
Steven Yakubov ◽  
...  
Keyword(s):  
High Risk ◽  
Pivotal Trial ◽  
Risk Of Mortality ◽  
Predicted Risk

scholarly journals COVID-19 in ESRD and Acute Kidney Injury

2020 ◽  
pp. 1-11
Author(s):  
Jeroen P. Kooman ◽  
Frank M. van der Sande
Keyword(s):  
Acute Kidney Injury ◽  
General Population ◽  
Kidney Injury ◽  
Severe Infection ◽  
Clinical Situation ◽  
System A ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
The Face ◽  
Severe Comorbidity

The COVID-19 pandemic has greatly affected nephrology. Firstly, dialysis patients appear to be at increased risk for infection due to viral transmission next to an enhanced risk for mortality as compared to the general population, even in the face of an often apparently mild clinical presentation. Derangements in the innate and adaptive immune systems may be responsible for a reduced antiviral response, whereas chronic activation of the innate immune system and endothelial dysfunction provide a background for a more severe course. The presence of severe comorbidity, older age, and a reduction of organ reserve may lead to a rapid deterioration of the clinical situation of the patients in case of severe infection. Secondly, patients with COVID-19 are at increased risk of acute kidney injury (AKI), which is related to the severity of the clinical disease. The presence of AKI, and especially the need for renal replacement therapy (RRT), is associated with an increased risk of mortality. AKI in COVID-19 has a multifactorial origin, in which direct viral invasion of kidney cells, activation of the renin-angiotensin aldosterone system, a hyperinflammatory response, hypercoagulability, and nonspecific factors such as hypotension and hypoxemia may be involved. Apart from logistic challenges and the need for strict hygiene within units, treatment of patients with ESRD and COVID-19 is not different from that of the general population. Extracorporeal treatment of patients with AKI with RRT can be complicated by frequent filter clotting due to the hypercoagulable state, for which regional citrate coagulation provides a reasonable solution. Also, acute peritoneal dialysis may be a reasonable option in these patients. Whether adjuncts to extracorporeal therapies, such as hemoadsorption, provide additional benefits in the case of severely ill COVID-19 patients needs to be addressed in controlled studies.

Improved Outcomes With Integrated Intensivist Consultation for Cardiac Surgery Patients

2018 ◽  
Vol 33 (6) ◽  
pp. 576-582 ◽  
Author(s):  
Omer W. Sultan ◽  
Lori L. Boland ◽  
Tyler G. Kinzy ◽  
Roman R. Melamed ◽  
Susan C. Seatter ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Retrospective Cohort ◽  
Care Center ◽  
Risk Of Mortality ◽  
Improved Outcomes ◽  
Time Periods ◽  
The Impact ◽  
Predicted Risk ◽  
Adult Cardiac Surgery ◽  
Ventilator Time

This study examined the impact of integrated intensivist consultation in the immediate postoperative period on outcomes for cardiac surgery patients. A retrospective cohort study was conducted in 1711 adult cardiac surgery patients from a single quaternary care center in Minnesota. Outcomes were compared across 2 consecutive 2-year time periods reflecting an elective intensivist model (n = 801) and an integrated intensivist model (n = 910). Patients under the 2 models were comparable with respect to demographics, comorbidities, procedure types, and Society for Thoracic Surgery predicted risk of mortality score; however, patients in the earlier cohort were slightly older and more likely to have chronic kidney disease ( P = .003). Integrated intensivist involvement was associated with reduced postoperative ventilator time, length of stay (LOS), stroke, encephalopathy, and reoperations for bleeding (all P < .01) but was not associated with mortality. Intensivist integration into the postoperative care of cardiac surgery patients may reduce ventilator time, LOS, and complications but may not improve survival.

scholarly journals Predicted Risk of Mortality, Transfusion, and Postoperative Outcomes in Isolated Primary Valve Operations

2016 ◽  
Vol 101 (2) ◽  
pp. 620-624 ◽  
Author(s):  
W. Brent Keeling ◽  
Jose Binongo ◽  
Eric L. Sarin ◽  
Bradley G. Leshnower ◽  
Edward P. Chen ◽  
...  
Keyword(s):  
Postoperative Outcomes ◽  
Risk Of Mortality ◽  
Predicted Risk

Robotic Beating Heart Totally Endoscopic Coronary Artery Bypass in Higher-Risk Patients

2018 ◽  
Vol 13 (2) ◽  
pp. 108-113 ◽  
Author(s):  
Husam H. Balkhy ◽  
Sarah Nisivaco ◽  
Hiroto Kitahara ◽  
Mackenzie McCrorey ◽  
Brooke Patel
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Risk Group ◽  
Artery Bypass ◽  
Beating Heart ◽  
Risk Of Mortality ◽  
Risk Patients ◽  
Predicted Risk

Objective Patients with a high Society of Thoracic Surgeons (STS) predicted risk of mortality undergoing coronary artery bypass surgery are known to have worse outcomes. Less invasive approaches have been shown to improve morbidity and mortality for these patients. In this study, we examined perioperative outcomes in higher-risk patients undergoing robotic totally endoscopic beating heart coronary artery bypass surgery. Methods The STS predicted risk of mortality was reviewed for patients undergoing robotic totally endoscopic beating heart coronary artery bypass surgery at our institution between January 2013 and May 2017. We identified a higher-risk cohort (n = 50) and compared them to a lower-risk cohort (n = 220) during the same period. The higher-risk group was formed from patients with the 50 highest STS scores. Perioperative data were collected retrospectively. Results There were 50 patients in the higher-risk group (mean STS score = 7.05 ± 4.9, mean age = 73 years) and 220 patients in the lower-risk group (mean STS score = 0.89 ± 0.6, mean age = 64 years). The higher-risk group had significantly greater rates of renal insufficiency, peripheral vascular disease, and lower ejection fraction. The incidence of postoperative re-exploration for bleeding, stroke, myocardial infarction, and prolonged ventilation was similar. Perioperative blood transfusion and hospital length of stay were greater in the higher-risk group. Mortality was lower in the higher-risk group (0% vs 1.8% P = 0.045). Cardiac-related mortality was similar at midterm follow-up. Conclusions We conclude that beating heart totally endoscopic beating heart coronary artery bypass surgery can be performed in patients with a higher STS predicted risk of mortality with excellent outcomes. Further studies are warranted to evaluate long-term results of totally endoscopic beating heart coronary artery bypass surgery in this challenging group of patients.

scholarly journals Comparison of Transvalvular Aortic Mean Gradients Obtained by Intraprocedural Echocardiography and Invasive Measurement in Balloon and Self‐Expanding Transcatheter Valves

2021 ◽  
Author(s):  
Amr E. Abbas ◽  
Ramy Mando ◽  
Amer Kadri ◽  
Houman Khalili ◽  
George Hanzel ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Poor Correlation ◽  
Weak Correlation ◽  
Transcatheter Aortic Valve ◽  
Risk Of Mortality ◽  
Before And After ◽  
Transcatheter Valves ◽  
Predicted Risk ◽  
Low Ejection Fraction ◽  
Invasive Measurement

Background Concerns about discordance between echocardiographic and invasive mean gradients after transcatheter aortic valve replacement (TAVR) with balloon‐expandable valves (BEVs) versus self‐expanding valves (SEVs) exist. Methods and Results In a multicenter study, direct‐invasive and echocardiography‐derived transvalvular mean gradients obtained before and after TAVR were compared as well as post‐TAVR and discharge echocardiographic mean gradients in BEVs versus SEVs in 808 patients. Pre‐TAVR, there was good correlation ( R =0.614; P <0.0001) between direct‐invasive and echocardiography‐derived mean gradients and weak correlation ( R =0.138; P <0.0001) post‐TAVR. Compared with post‐TAVR echocardiographic mean gradients, both valves exhibit lower invasive and higher discharge echocardiographic mean gradients. Despite similar invasive mean gradients, a small BEV exhibits higher post‐TAVR and discharge echocardiographic mean gradients than a large BEV, whereas small and large SEVs exhibit similar post‐TAVR and discharge mean gradients. An ejection fraction <50% ( P =0.028) and higher Society of Thoracic Surgeons predicted risk of mortality score ( P =0.007), but not invasive or echocardiographic mean gradient ≥10 mm Hg ( P =0.378 and P =0.341, respectively), nor discharge echocardiographic mean gradient ≥20 mm Hg ( P =0.393), were associated with increased 2‐year mortality. Conclusions Invasively measured and echocardiography‐derived transvalvular mean gradients correlate well in aortic stenosis but weakly post‐TAVR. Post‐TAVR, echocardiography overestimates transvalvular mean gradients compared with invasive measurements, and poor correlation suggests these modalities cannot be used interchangeably. Moreover, echocardiographic mean gradients are higher on discharge than post‐TAVR in all valves. Despite similar invasive mean gradients, a small BEV exhibits higher post‐TAVR and discharge echocardiographic mean gradients than a large BEV, whereas small and large SEVs exhibit similar post‐TAVR and discharge mean gradients. Immediately post‐TAVR, elevated echocardiographic‐derived mean gradients should be assessed with caution and compared with direct‐invasive mean gradients. A low ejection fraction and higher Society of Thoracic Surgeons score, but not elevated mean gradients, are associated with increased 2‐year mortality.

The Society of Thoracic Surgeons 30-Day Predicted Risk of Mortality Score Also Predicts Long-Term Survival

2012 ◽  
Vol 93 (1) ◽  
pp. 26-35 ◽  
Author(s):  
John D. Puskas ◽  
Patrick D. Kilgo ◽  
Vinod H. Thourani ◽  
Omar M. Lattouf ◽  
Edward Chen ◽  
...  
Keyword(s):  
Term Survival ◽  
Long Term Survival ◽  
Risk Of Mortality ◽  
Predicted Risk

Evaluation of the Performance of ACS NSQIP Surgical Risk Calculator in Emergency General Surgery Patients

2020 ◽  
Vol 86 (2) ◽  
pp. 83-89
Author(s):  
Andrea M. Long ◽  
Amy N. Hildreth ◽  
Patrick T. Davis ◽  
Rebecca Ur ◽  
Ashley T. Badger ◽  
...  
Keyword(s):  
General Surgery ◽  
Outcome Expectations ◽  
Poor Correlation ◽  
Risk Calculator ◽  
Inclusion Criteria ◽  
Emergency General Surgery ◽  
Surgical Risk ◽  
Acs Nsqip ◽  
Risk Of Mortality ◽  
Predicted Risk

The ACS NSQIP Surgical Risk Calculator is designed to estimate the chance of an unfavorable outcome after surgery. Our goal was to evaluate the accuracy of the calculator in our emergency general surgery population. Surgical outcomes were compared to predicted risk. The risk was calculated with surgeon adjustment scores (SASs) of 1 (no adjustment), 2 (risk somewhat higher), and 3 (risk significantly higher than estimate). Two hundred and twenty-seven patients met the inclusion criteria. An SAS of 1 or 2 accurately predicted risk of mortality (5.7% and 8.5% predicted versus 7.9% actual), whereas a risk adjustment of 3 indicated significant overestimation of mortality rate (14.8% predicted). There was good overall prediction performance for most variables with no clear preference for SAS 1, 2, or 3. Poor correlation was seen with SSI, urinary tract infection, and length of stay variables. The ACS NSQIP Surgical Risk Calculator yields valid predictions in the emergency general surgery population, and the data support its use to inform conversations about outcome expectations.

Sign in / Sign up

Export Citation Format

Share Document