Original articleCardiovascularHigh-Risk Aortic Valve Replacement: Are the Outcomes as Bad as Predicted?
Section snippets
Patient Selection
This study was conducted with the approval of the New York University (NYU) School of Medicine Institutional Review Board with specific waiver of the need for individual patient consent. Between January 1996 and March 2006, 1507 consecutive patients underwent isolated AVR at the NYU Medical Center. Of these, 731 patients (48.5%) had an additive EuroSCORE of 7 or greater and were identified as high-risk patients. Operative techniques included direct aortic clamping, moderate systemic
Results
Of the 1507 patients who underwent isolated AVR between January 1996 and March 2006, 731 had a EuroSCORE of 7 or higher and were identified as high risk; 332 had a EuroSCORE of 10 or higher. The demographics and preoperative characteristics of this cohort are listed in Table 1. Notably, 313 (42.8%) were septuagenarians, 322 (44.0%) were octogenarians or nonagenarians, 233 (31.9%) had previous cardiac surgery, 127 (17.4%) had cerebrovascular disease, 69 (9.4%) had a low ejection fraction (EF),
Comment
The reported major adverse prognostic indicators for patients undergoing AVR include advanced age [21, 22, 23], impaired left ventricular systolic function [24, 25, 26], and the presence of renal disease [23, 27], all of which are factored into the calculation of the EuroSCORE. In fact, the EuroSCORE system has been shown to be one of the most accurate risk-stratification models for cardiac surgery. Geissler and colleagues [28] reported that the EuroSCORE had the highest predictive value among
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