The dilemma of surgical or percutaneous approach in aortic stenosis: A reliable risk score is needed
Article Outline
We have read with interest the article written by Piazza et al1 that was related with the EuroScore and the Society of Thoracic Surgeons Predicted Risk of Mortality score in CoreValve prosthesis implantation. The main finding of the study is the suboptimal discriminatory power and calibration of both index. The authors raise the question of the role of the surgical risk scores in selecting patients and predicting outcomes in transcatheter aortic valve implantation. We fully agree with their opinion, but we believe that the problem is even more profound because it is not possible to predict reliably the outcomes not only in percutaneous valve implantation but also in surgical replacement. It is becoming a constant in recent series that the logistic EuroScore overestimates the surgical risk in aortic valve replacement.2 As was demonstrated in a large series, the more recent the era of operation, the more pronounced is the discrepancy between expected and observed mortalities.3 In the same way, in a cohort of octogenarians who underwent aortic valve replacement in our center between 1996 and 2006, we found that the logistic EuroScore predicted twice the observed mortality.4 Since the introduction of the percutaneous devices a few years ago, the logistic EuroScore has been the most widely used tool to determine the surgical risk. Although at the beginning transcatheter valve implantation was reserved for nonsurgical patients, its progression is being exponential, and it is becoming a daily challenge to decide between surgical or percutaneous techniques in octogenarians. Moreover, with the forthcoming devices in the next 5 years, probably this dilemma will include younger subgroups of patients, and we believe that it is imperative to have a useful and reliable risk score to choose the best treatment.
References
- . Relationship between the logistic EuroScore and the Society of Thoracic Surgeons Predicted Risk of Mortality score in patients implanted with the CoreValve ReValving System—a Bern-Rotterdam Study. Am Heart J. 2010;159:323–329
- Valvular surgery in octogenarians: operative risks factors, evaluation of Euroscore and long term results. Eur J Cardiothorac Surg. 2005;27:276–280
- Overestimation of aortic valve replacement risk by EuroSCORE: implications for percutaneous valve replacement. Eur Heart J. 2009;30:74–80
- The logistic EuroScore overestimates the surgical risk of aortic valve replacement in octogenarians with aortic stenosis. Rev Esp Cardiol. 2008;61(Suppl 3):105
PII: S0002-8703(10)00412-6
doi:10.1016/j.ahj.2010.05.006
© 2010 Mosby, Inc. All rights reserved.
Refers to article:
- Relationship between the logistic EuroSCORE and the Society of Thoracic Surgeons Predicted Risk of Mortality score in patients implanted with the CoreValve ReValving System—A Bern-Rotterdam Study
