Both isolated tricuspid replacement and repair were associated with significant but acceptable early and late mortality with no statistically significant difference in cumulative survival. Preoperative loop diuretic dose, haemoglobin and creatinine are individually associated with survival and/or reoperation after isolated tricuspid valve surgery.
Mitral valve replacement candidates had more baseline risk factors and higher raw rates of postoperative mortality and morbidity, which did not reach statistical significance.
Decision making regarding surgery for acute bacterial endocarditis is complex given its heterogeneity and often fatal course. Few studies have investigated the utility of operative risk scores in this setting. Endocarditis-specific scores have recently been developed. We assessed the prognostic utility of contemporary risk scores for mortality and morbidity after endocarditis surgery. Additive and logistic EuroSCORE I, EuroSCORE II, additive Society of Thoracic Surgeon's (STS) Endocarditis Score and additive De Feo-Cotrufo Score were retrospectively calculated for patients undergoing surgery for endocarditis during 2005-2011. Pre-specified primary outcomes were operative mortality, composite morbidity and mortality during follow-up. A total of 146 patients were included with an operative mortality of 6.8 % followed for 4.1 ± 2.4 years. Mean scores were additive EuroSCORE I: 8.0 ± 2.5, logistic EuroSCORE I: 13.2 ± 10.1 %, EuroSCORE II: 9.1 % ± 9.4 %, STS Score: 32.2 ± 13.5 and De Feo-Cotrufo Score: 14.6 ± 9.2. Corresponding areas under curve (AUC) for operative mortality 0.653, 0.645, 0.656, 0.699 and 0.744; for composite morbidity were 0.623, 0.625, 0.720, 0.714 and 0.774; and long-term mortality 0.588, 0.579, 0.686, 0.735 and 0.751. The best tool for post-operative stroke was EuroSCORE II: AUC 0.837; for ventilation >24 h and return to theatre the De Feo-Cotrufo Scores were: AUC 0.821 and 0.712. Pre-operative inotrope or intra-aortic balloon pump treatment, previous coronary bypass grafting and dialysis were independent predictors of operative and long-term mortality. In conclusion, risk models developed specifically from endocarditis surgeries and incorporating endocarditis variables have improved prognostic ability of outcomes, and can play an important role in the decision making towards surgery for endocarditis.
Atrial fibrillation (Afib) contributes significantly to overall cardiovascular risk. Widespread screening for Afib in primary care is sometimes performed by palpation, but suffers from low accuracy and is dependent on clinician experience. Algorithms implemented on oscillometric blood pressure devices can detect Afib with high sensitivity and specificity, but information on factors affecting accuracy is scant. Concurrent diagnostic electrocardiogram (ECG) and oscillometry were measured in participants in ECG clinics at two sites. Root mean squared successive difference (RMSSD) and irregularity index (Irrx) were calculated from oscillometric data and used to train logistic regression classifiers. Monte Carlo cross validation with 20 splits was performed to estimate confidence intervals for mean sensitivity and specificity, with various weightings, in the absence or presence of ectopics, and with or without repeated measurements. 707 measurements, including 168 Afib, were collected from 569 participants with mean (standard deviation) age of 63 (16) years. Sensitivity/specificity of RMSSD and Irrx were 0.982/0.908 and 0.986/0.960 respectively when ectopics were included. Excluding ectopics from the data improved specificity by up to 5%. Nevertheless, based on this performance and after accounting for prevalence of Afib in the population aged over 60 years, and estimated costs of healthcare, oscillometric screening for Afib in this age group could return a positive net health-economic benefit.
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