ABSTRACT
OBJECTIVES: To compare and validate the new European System for Cardiac Operative Risk Evaluation (EuroSCORE) II with EuroSCORE at our institution. METHODS: The logistic EuroSCORE and EuroSCORE II were calculated on the entire patient cohort undergoing major cardiac surgery at our centre between January 2005 and December 2010. The goodness of fit was compared by means of the Hosmer-Lemeshow (HL) chi-squared test and the area under the curve (AUC) of the receiver operating characteristic curves of both scales applied to the same sample of patients. These analyses were repeated and stratified by the type of surgery. RESULTS: Mortality of 5.66% was observed, with estimated mortalities according to logistic EuroSCORE and EuroSCORE II of 9 and 4.46%, respectively. The AUC for EuroSCORE (0.82, 95% confidence interval [CI] 0.79-0.85) was lower than that for EuroSCORE II (0.85, 95% CI 0.83-0.87) without the differences being statistically significant (P = 0.056). Both scales showed a good discriminative capacity for all the pathologies subgroups. The two scales showed poor calibration in the sample: EuroSCORE (χ(2) = 39.3, P(HL) < 0.001) and EuroSCORE II (χ(2) = 86.69, P(HL) < 0.001). The calibration of EuroSCORE was poor in the groups of patients undergoing coronary (P(HL) = 0.01), valve (P(HL) = 0.01) and combined coronary valve surgery (P(HL) = 0.012); and that of EuroSCORE II in the group of coronary (P(HL) = 0.001) and valve surgery (P(HL) < 0.001) patients. CONCLUSIONS: EuroSCORE II demonstrated good discriminative capacity and poor calibration in the patients undergoing major cardiac surgery at our centre.
Subject(s)
Cardiac Surgical Procedures/mortality , Decision Support Techniques , Aged , Area Under Curve , Cardiac Surgical Procedures/adverse effects , Chi-Square Distribution , Discriminant Analysis , Female , Humans , Logistic Models , Male , Middle Aged , ROC Curve , Reproducibility of Results , Retrospective Studies , Risk Assessment , Risk Factors , Spain , Treatment OutcomeABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Thoracic Surgery/methods , Mitral Valve , Mitral Valve Insufficiency/surgery , Heart-Assist Devices/trends , Heart-Assist Devices , Echocardiography/methods , Echocardiography , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/diagnosis , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/diagnosis , Mitral Valve/surgery , Mitral Valve Insufficiency , Mitral Valve AnnuloplastyABSTRACT
An 83-year-old patient underwent a transapical aortic valve implantation at our institution. Four months later, she was readmitted to our institution because of fever and heart failure. A prosthetic aortic valve endocarditis was diagnosed. Because of the high surgical risk, surgery was refused and the patient died shortly after the diagnosis. We briefly discuss the implications of this finding in the prevention of infective endocarditis after transcatheter aortic valve implantation.
Subject(s)
Aortic Valve Stenosis/therapy , Cardiac Catheterization/adverse effects , Endocarditis, Bacterial/microbiology , Enterococcus faecalis/isolation & purification , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis/adverse effects , Prosthesis-Related Infections/microbiology , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Cardiac Catheterization/instrumentation , Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/drug therapy , Fatal Outcome , Female , Heart Valve Prosthesis Implantation/instrumentation , Humans , Prosthesis-Related Infections/diagnostic imaging , Prosthesis-Related Infections/drug therapy , Severity of Illness Index , Treatment Outcome , UltrasonographySubject(s)
Heart Rupture/microbiology , Hemorrhage/microbiology , Mediastinitis/microbiology , Negative-Pressure Wound Therapy/adverse effects , Sternotomy/adverse effects , Surgical Wound Infection/microbiology , Anti-Bacterial Agents/therapeutic use , Drainage , Heart Rupture/diagnostic imaging , Heart Rupture/therapy , Heart Ventricles/microbiology , Hemorrhage/diagnostic imaging , Hemorrhage/therapy , Hemostatic Techniques , Humans , Mediastinitis/diagnostic imaging , Mediastinitis/therapy , Radiography , Reoperation , Surgical Wound Dehiscence/microbiology , Surgical Wound Infection/diagnostic imaging , Surgical Wound Infection/therapy , Suture Techniques , Treatment OutcomeABSTRACT
Pregnant women with a mechanical heart prosthesis are at a higher risk of thromboembolic complications. The optimal anticoagulation strategy in this setting remains unclear. When prosthesis thrombosis happens and cardiac surgery must be performed, the risk of fetal mortality is high. Special attention must be paid to improve the placental perfusion during cardiopulmonary bypass (CPB) in order to improve fetal outcomes. A 31-year-old woman, nine weeks pregnant, was admitted to our institution due to a mitral mechanical prosthesis thrombosis. She had been receiving low molecular weight heparin (LMWH) since pregnancy was detected. She underwent a mitral valve replacement with CPB at 34 degrees C and a short cardiac arrest time. Both mother and fetus survived. We briefly review the different anticoagulation options during pregnancy and perfusion strategies on CPB to improve fetal outcomes.
Subject(s)
Cardiopulmonary Bypass , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis , Pregnancy Complications, Cardiovascular/surgery , Thrombosis/surgery , Adult , Anticoagulants/therapeutic use , Cardiopulmonary Bypass/adverse effects , Device Removal , Female , Fetal Death/prevention & control , Heart Valve Prosthesis Implantation/adverse effects , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Placental Circulation , Pregnancy , Pregnancy Complications, Cardiovascular/diagnostic imaging , Pregnancy Complications, Cardiovascular/etiology , Pregnancy Complications, Cardiovascular/physiopathology , Pregnancy Trimester, First , Prosthesis Failure , Reoperation , Sternotomy , Thrombosis/diagnostic imaging , Thrombosis/etiology , Thrombosis/physiopathology , Treatment Outcome , UltrasonographyABSTRACT
La esternotomía media sigue siendo el 'patrón oro' de las incisiones para acceder al corazón. Los principales inconvenientes son la osteomielitis y mediastinitis, infrecuentes pero muy graves, el impacto estético de una incisión potencialmente quelógena, amplia y en un lugar muy visible de la línea media y, por último, la insuficiencia respiratoria consecutiva al dolor y a la inestabilidad esternal. Se han desarrollado otras vías de acceso intentando reducir estas complicaciones y disminuir al mismo tiempo la estancia hospitalaria, el dolor y el coste. De las muchas variantes descritas hasta el momento, la miniesternotomía en 'J' parece la técnica más aceptada. A pesar de las numerosas series publicadas, son muy escasas las que comparan prospectiva y aleatoriamente las técnicas convencionales con los procedimientos menos invasivos, por lo que los beneficios de la nueva técnica están aún por demostrar .Pese a ello, creemos que la esternotomía en 'J' tiene indudables ventajas estéticas, menores complicaciones en pacientes con patología pulmonar, solución más sencilla en caso de mediastinitis u osteomielitis y menores adherencias para cirugías ulteriores (AU)
