Simple scoring system to predict in-hospital mortality after surgery for infective endocarditis

BACKGROUND: Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. METHODS AND RESULTS: Outcomes of 361 consecutive patients (mean age, 59.1\ub115.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate 55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734-0.822). The score performed better than 5 of 6 scoring systems for in-hospital death after cardiac surgery that were considered. CONCLUSIONS: A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE

Modeling the impact of oyster culture on a mudflat food web in Marennes-Oléron Bay (France)

International audienceWe used a carbon-based food web model to investigate the effects of oyster cultivation on the ecosystem of an intertidal mudflat. A previously published food web model of a mudflat in Marennes-Oléron Bay, France, was updated with revised parameters, and a realistic surface area and density of existing oyster cultures on the mudflat. We developed 2 hypothetical scenarios to estimate the impact of oyster cultivation on the food web structure of the ecosystem: one with no oysters, the other with a doubled area devoted to cultivated oysters in the bay. Oysters are direct trophic competitors of other filter feeders, and their presence modifies benthic-pelagic coupling by forcing a shift from pelagic consumers to benthic consumers. Increasing the surface area of cultivated oysters caused secondary production to increase, providing food for top predators (in particular juvenile nekton), reinforcing the nursery role of the mudflat in the ecosystem, and altering the species composition available to the top predators

Modeling the impact of oyster culture on a mudflat food web in Marennes-Oléron Bay (France)

International audienceWe used a carbon-based food web model to investigate the effects of oyster cultivation on the ecosystem of an intertidal mudflat. A previously published food web model of a mudflat in Marennes-Oléron Bay, France, was updated with revised parameters, and a realistic surface area and density of existing oyster cultures on the mudflat. We developed 2 hypothetical scenarios to estimate the impact of oyster cultivation on the food web structure of the ecosystem: one with no oysters, the other with a doubled area devoted to cultivated oysters in the bay. Oysters are direct trophic competitors of other filter feeders, and their presence modifies benthic-pelagic coupling by forcing a shift from pelagic consumers to benthic consumers. Increasing the surface area of cultivated oysters caused secondary production to increase, providing food for top predators (in particular juvenile nekton), reinforcing the nursery role of the mudflat in the ecosystem, and altering the species composition available to the top predators

Anticoagulation or antiplatelet therapy of bioprosthetic heart valves recipients: an unresolved issue

Improvements in the performance and longevity of biological valve prostheses have steadily increased their rates of implantation in recent years. Aortic bioprostheses, which are commonly used in the elderly or when the risks of anticoagulating are high, have generally been associated with low rates of long-term complications. Freedom from anticoagulation, therefore, represents the main theoretical advantage of biological, compared with mechanical, aortic prostheses. While a variety of anticoagulant and antiplatelet drug regimens have been described, a precise antithrombotic protocol for the early postoperative period after bioprosthetic aortic valve replacement has not been developed. There are also important differences between the international guidelines published. This review examines the clinical evidence concerning the use of vitamin K antagonist and antiplatelet therapy in the early management of the antithrombotic complications after bioprosthetic aortic valve replacement

Anticoagulation or antiplatelet therapy of bioprosthetic heart valves recipients: an unresolved issue.

Improvements in the performance and longevity of biological valve prostheses have steadily increased their rates of implantation in recent years. Aortic bioprostheses, which are commonly used in the elderly or when the risks of anticoagulating are high, have generally been associated with low rates of long-term complications. Freedom from anticoagulation, therefore, represents the main theoretical advantage of biological, compared with mechanical, aortic prostheses. While a variety of anticoagulant and antiplatelet drug regimens have been described, a precise antithrombotic protocol for the early postoperative period after bioprosthetic aortic valve replacement has not been developed. There are also important differences between the international guidelines published. This review examines the clinical evidence concerning the use of vitamin K antagonist and antiplatelet therapy in the early management of the antithrombotic complications after bioprosthetic aortic valve replacement