Carlos Morales

Hernandez-Vaquero Daniel

Jacobo Silva

Rocio Diaz

Ruben Alvarez-Cabo

Journal of Cardiothoracic Surgery

Springer - Publisher Connector

MEETING ABSTRACT Open Access
Performance of EuroSCORE II in octogenarians
with comorbidities undergoing aortic valve
replacement
Hernandez-Vaquero Daniel*, Rocio Diaz, Ruben Alvarez-Cabo, Carlos Morales, Jacobo Silva
From World Society of Cardiothoracic Surgeons 25th Anniversary Congress, Edinburgh
Edinburgh, UK. 19-22 September 2015
Background/Introduction
EuroSCORE II is being used to select high-risk patients
who are candidates for transcatheter procedures. The
majority of these patients are octogenarians with comor-
bidities. However, to date, no studies have evaluated the
performance of EuroSCORE II in octogenarians with
renal insufficiency or left ventricular dysfunction.
Aims/Objectives
To know the performance of EuroSCORE II in octogen-
arian patients with severe renal insufficiency and ventri-
cular dysfunction who undergo traditional aortic valve
replacement.
Method
All octogenarians who underwent aortic valve replacement
between 2009 and 2015 in our center were analyzed. Crea-
tinine clearance was assessed using Cockroft- Gault for-
mula as recommended for authors of EuroSCORE II.
Severe renal insufficiency was considered when the creati-
nine clearance was <50 ml/min as indicated in Euro-
SCORE II. Ventricular dysfunction was considered when
the left ventricular ejection fraction was <50%. Discrimina-
tion was evaluated by the area under the receiver operat-
ing curve (AROC) and for calibration value of p for
Hosmer-Lemeshow test and risk adjusted mortality ratio
(RAMR) were calculated.
Results
482 octogenarian patients underwent traditional aortic
valve replacement during the study period. Between
these patients, 120 (24,9%) had severe renal insufficiency
and 78 (16,2%) had left ventricular dysfunction. 18,3% of
patients with severe renal insufficiency and 17,9% of
patients with ventricular dysfunction died. Discrimina-
tion was very good in both subgroups with an AROC of
0,88 and 0,85 for patients with renal insufficiency and
left ventricular dysfunction respectively. However, cali-
bration was poor. Hosmer-Lemeshow test showed a
value of p = 0,02 and 0,075 for patients with renal insuf-
ficiency and ventricular dysfunction and RAMR showed
much more observed mortality than expected (RAMR =
18,3/8,9 = 2,05 and 17,9/11,4 = 1,6) Logistic Euro-
SCORE showed the best calibration accuracy.
Discussion/Conclusion
Using the formula recommended for EuroSCORE II, 25%
of the octogenarians undergoing aortic valve replacement
have severe renal insufficiency. In these patients and in
those with left ventricular dysfunction EuroSCORE II is
able to accurately distinguish patients at high surgical
risk. However, EuroSCORE II underestimates the real
risk of octogenarians with these risk factors and the logis-
tic EuroSCORE has the best calibration accuracy.
Published: 16 December 2015
doi:10.1186/1749-8090-10-S1-A57
Cite this article as: Daniel et al.: Performance of EuroSCORE II in
octogenarians with comorbidities undergoing aortic valve replacement.
Journal of Cardiothoracic Surgery 2015 10(Suppl 1):A57.
Cardiac Surgery Department, Central University Hospital of Asturias, Oviedo,
Spain
Daniel et al. Journal of Cardiothoracic Surgery 2015, 10(Suppl 1):A57
http://www.cardiothoracicsurgery.org/content/10/S1/A57
© 2015 Daniel et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://
creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/
zero/1.0/) applies to the data made available in this article, unless otherwise stated.


Performance of EuroSCORE II in octogenarians with comorbidities undergoing aortic valve replacement

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Performance of EuroSCORE II in octogenarians with comorbidities undergoing aortic valve replacement

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