Cardiac Surgery in Patients with Liver Cirrhosis (CASTER) study: early and long-term outcomes

BACKGROUND: patients with liver cirrhosis (LC) undergoing cardiac surgery (CS) face perioperative high mortality and morbidity, but extensive studies on this topic are lacking.METHODS: All adult patients with LC undergoing a CS procedure between 2000-2017 at ten Italian Institutions were included in this retrospective cohort study. LC was classified according to preoperative Child-Turcotte-Pugh (CTP) Score and Model for End-Stage Liver Disease (MELD) score. Early and medium-term outcomes analysis was performed in the overall population and according to CTP classes.RESULTS: The study population included 144 patients (mean age:66\ub19 years; male=69%). Ninety-eight, 20 and 26 patients were in CTP class-A, in early (MELD <12) or advanced (MELD >12) CTP class-B respectively. The main LC etiologies were viral (43%) and alcoholic (36%). Liver-related clinical presentation (ascites, esophageal varices and encephalopathy) and laboratory values (EGFR, serum albumin and bilirubin, platelet count) significantly worsened across the CTP-classes(p=.001). CABG or valve surgery (87% bioprosthesis) were performed in 36% and 50% respectively. Postoperative complications (especially AKI, liver complication and LOS) significantly worsened in advanced CTP class-B(p=.001). Notably, observed mortality was 3 or 4-fold higher than the EuroscoreII-predicted mortality, in the overall population, and in the subgroups. At Kaplan-Meier analysis, 1- and 5-years cumulative survival in the overall population was 82\ub13% and 77\ub14% respectively. The 5-years survival in CTP class A, early- and advanced-B was 72\ub15%, 68\ub111% and 61\ub110% respectively(p=.238).CONCLUSIONS: CS outcomes in patients with LC are significantly affected in relation to the extent of preoperative liver dysfunction, but in the early CTP classes medium-term survival is acceptable. Further analysis are needed to better estimate the preoperative risk stratification of these patients

Corrigendum to \u201cA predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE\u201d. [Int. J. Cardiol. 241 (Aug 15 2017) 97\u2013102](S0167527317309877)(10.1016/j.ijcard.2017.03.148)

The authors regret that the first name and last name of the author Sandro Sponga was published incorrectly in the original version and this has now been corrected

A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE

Background The aim of this large retrospective study was to provide a logistic risk model along an additive score to predict early mortality after surgical treatment of patients with heart valve or prosthesis infective endocarditis (IE). Methods From 2000 to 2015, 2715 patients with native valve endocarditis (NVE) or prosthesis valve endocarditis (PVE) were operated on in 26 Italian Cardiac Surgery Centers. The relationship between early mortality and covariates was evaluated with logistic mixed effect models. Fixed effects are parameters associated with the entire population or with certain repeatable levels of experimental factors, while random effects are associated with individual experimental units (centers). Results Early mortality was 11.0% (298/2715); At mixed effect logistic regression the following variables were found associated with early mortality: age class, female gender, LVEF, preoperative shock, COPD, creatinine value above 2\ua0mg/dl, presence of abscess, number of treated valve/prosthesis (with respect to one treated valve/prosthesis) and the isolation of Staphylococcus aureus, Fungus spp., Pseudomonas Aeruginosa and other micro-organisms, while Streptococcus spp., Enterococcus spp. and other Staphylococci did not affect early mortality, as well as no micro-organisms isolation. LVEF was found linearly associated with outcomes while non-linear association between mortality and age was tested and the best model was found with a categorization into four classes (AUC\ua0=\ua00.851). Conclusions The following study provides a logistic risk model to predict early mortality in patients with heart valve or prosthesis infective endocarditis undergoing surgical treatment, called \u201cThe EndoSCORE\u201d