Is the EuroSCORE II reliable in surgical mitral valve repair? A single-centre validation study

Abstract

OBJECTIVES The EuroSCORE II is widely used to predict 30-day mortality in patients undergoing open and transcatheter cardiac surgery. The aim of this study is to evaluate the discriminatory ability of the EuroSCORE II in predicting 30-day mortality in a large cohort of patients undergoing surgical mitral valve repair in a high-volume centre. METHODS A retrospective review of our institutional database was carried on to find all patients who underwent mitral valve repair in our department from January 2012 to December 2019. Discrimination of the EuroSCORE II was assessed using receiver operating characteristic curves. The maximum Youden’s Index was employed to define the optimal cut-point. Calibration was assessed by generating calibration plot that visually compares the predicted mortality with the observed mortality. Calibration was also tested with the Hosmer–Lemeshow goodness-of-fit test. Finally, the accuracy of the models was tested calculating the Brier score. RESULTS A total of 2645 patients were identified, and the median EuroSCORE II was 1.3% (0.6–2.0%). In patients with degenerative mitral regurgitation (MR), the EuroSCORE II showed low discrimination (area under the curve 0.68), low accuracy (Brier score 0.27) and low calibration with overestimation of the 30-day mortality. In patients with secondary MR, the EuroSCORE II showed a good overall performance estimating the 30-day mortality with good discrimination (area under the curve 0.88), good accuracy (Brier score 0.003) and good calibration. CONCLUSIONS In patients with degenerative MR operated on in a high-volume centre with a high level of expertise in mitral valve repair, the EuroSCORE II significantly overestimates the 30-day mortality.

After a 5-year follow-up, would you repair the mitral valve or replace it?

“…That could be due to reduced heart function as a result of the disease, and the acute side effects of CPB and cardioplegia which may cause an impairment in heart function in the first few hours after surgery, thus increasing the probability of developing low-cardiac output syndrome and the respective impact. Similar to Carino et al (13), our study showed that a high EuroSCORE II was associated with an increased 30-day mortality and higher adverse long-term outcomes. EuroSCORE II is widely considered an important predictor for 30-day mortality after cardiac surgery.…”

“…EuroSCORE II is widely considered an important predictor for 30-day mortality after cardiac surgery. It was validated in some studies in patients undergoing MV surgery (13,21,22) but we only found one study that explored the ability of EuroSCORE II to predict the 30-day mortality in patients undergoing MV surgery. They found that EuroSCORE II overestimates 30-day mortality (13).…”

“…It was validated in some studies in patients undergoing MV surgery (13,21,22) but we only found one study that explored the ability of EuroSCORE II to predict the 30-day mortality in patients undergoing MV surgery. They found that EuroSCORE II overestimates 30-day mortality (13). Some surgeons believe MV repair is more complex, requiring longer X-clamp time and having a higher risk of recurrence (19).…”

“…Clinically 73.4% of patients in MVRe and 79.7% in MVRp were admitted with NYHA classification III/IV (p=0.36). EuroSCORE II was used to predict the mortality risk in our population in a standard fashion (13). The median EuroSCORE II in MVRe was 1.5% (0.56%-14.4%) and 1.67% (0.5%-25.43%) in MVRp (p=0.2).…”

Intraoperative hemoadsorption in high-risk patients with infective endocarditis

“…Nonetheless, this is to the best of our knowledge the largest and first study to evaluate intraoperative hemoadsorption in a high-risk cohort undergoing cardiac surgery for infective endocarditis thus far. Regarding high-risk definition, the cutoff point for determining high-risk patients was set at a EuroSCORE II greater than 8% as the EuroSCORE II overestimates the operative mortality in cardiac surgical patients [ 30 , 31 ]. In order to compensate for this overestimation, we defined a high-risk patients as higher than 6% as in other studies.…”