Comparison Between Different Risk Scoring Algorithms on Isolated Conventional or Transcatheter Aortic Valve Replacement

Risk Assessment in Patient Selection for Transcatheter Aortic Valve Replacement

“…Conventional risk models for TAVR, such as the Society of Thoracic Surgeons (STS) risk calculator and the European System for Cardiac Operative Risk Evaluation (EUROSCORE), are derived from surgical data and have limited discrimination and calibration in the TAVR patient population. 2,3 It has proved difficult to develop TAVR-specific models to accurately predict risk given the heterogeneous patient population with multiple comorbidities and significant noncardiac competitive risk. Moreover, the role of patient preference and shared-decision making must be considered.…”

Cardiac surgery in the elderly: What goals of care?

“…Recently authors showed that the predictive value of many currently available risk-scoring algorithms (ACEF, EUROSCORE I and II, STS score) was insufficient to allow a precise and reliable risk assessment in patients undergoing surgical aortic valve replacement or transcather aortic valve implantation with an overestimation of risk using ACEF and conversely an overestimation of it using EUROSCORE or STS score [3].…”

“…Nowadays, in the setting of cardiac surgery, elderly patients are more likely to have extensive coronary artery disease and concomitant valvular disease, requiring combined cardiac intervention and need urgent or emergent surgery [2]; nevertheless, new surgery and anesthesiological techniques have resulted in sizeable benefits also for the elderly. However, the clinical and functional complexities of older patient candidate to cardiac surgery have highlighted the significant limitations regarding postoperative predictive power of current cardiac surgery risk scores such as EUROSCORE logistic I and II and STS score [3].…”

“…Nowadays, in the setting of cardiac surgery, elderly patients are more likely to have extensive coronary artery disease and concomitant valvular disease, requiring combined cardiac intervention and need urgent or emergent surgery [2]; nevertheless, new surgery and anesthesiological techniques have resulted in sizeable benefits also for the elderly. However, the clinical and functional complexities of older patient candidate to cardiac surgery have highlighted the significant limitations regarding postoperative predictive power of current cardiac surgery risk scores such as EUROSCORE logistic I and II and STS score [3].Recently authors showed that the predictive value of many currently available risk-scoring algorithms (ACEF, EUROSCORE I and II, STS score) was insufficient to allow a precise and reliable risk assessment in patients undergoing surgical aortic valve replacement or transcather aortic valve implantation with an overestimation of risk using ACEF and conversely an overestimation of it using EUROSCORE or STS score [3].The limitations of these risk models reside on their conceptualization and structure, mainly focused on cardiac specific parameters, and consequently in their inability to capture biological and functional vulnerability present in elderly patient and summarized by FRAILTY concept [4]. …”

Transcatheter Aortic Valve Implantation in Lower-Risk Patients With Aortic Stenosis

“…147 In the highest-risk patients, observed mortality was shown to be much closer to the STS-PROM (with an underestimation by a factor of 0.8) than to the LES (with a 3-fold overprediction). 148 Although the STS score outperformed LES, 149,150 EuroSCORE II, and age-creatinine-ejection fraction scores 150 in multiple studies, it can only provide moderate discriminatory power for predicting mortality after TAVI. 151 New versions of both the LES (EuroSCORE II) and the STS score (STS 2.73) have been developed, but data are still insufficient to judge their accuracy.…”