European Journal of Cardio-Thoracic Surgery 0 (2018) 1 LETTER TO THE EDITOR predicted mortality 1.93%). Leon et al.  in a prospective, randomized study How have task force members determined (2302 patients, with 81.3% of them with an STS score of between 4.0% and 8.0%, 30-day mortality 6.1% for TAVI, 8.0% for SAVR, P-value = 0.11) concluded the threshold value of EuroSCORE II for an that in intermediate-risk patients, TAVI was similar to SAVR with respect to the primary end point of death or disabling stroke at 2 years. Therefore, is it rational increased surgical risk in patients undergoing to favour TAVI over SAVR in all patients with an STS or EuroSCORE II value of aortic valve interventions? > _4%? Dusko Nezic*, Ivana Petrovic and Slobodan Micovic Clinic of Cardiac Surgery, Department of Cardiac Surgery, Dedinje REFERENCES Cardiovascular Institute, Belgrade, Serbia  Falk V, Baumgartner H, Bax J, DeBonis M, Hamm C, Holm PJ et al. 2017 Received 9 January 2018; accepted 27 February 2018 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2017;52:616–64. Keywords: Guidelines � Valvular management � Risk analysis  Nezic D, Ragus T, Micovic S, Trajic S, Spasojevic Milin B, Petrovic I et al. Clinical performances of EuroSCORE II risk stratiﬁcation model in Serbian We read with great interest the article by Falk et al.  regarding guidelines of cardiac surgical population: a single centre validation study including management strategies for an individual patient with a given valvular disease. 10048 patients. Vojnosanit Pregl 2017; doi: 10.2298/VSP170810172N. We do believe that the recommendation that favours transcatheter aortic valve  Arangalage D, Cimadevilla C, Alkhoder S, Chiampan A, Himbert D, Brochet E implantation (TAVI) versus surgical aortic valve replacement (SAVR) in patients et al. Agreement between the new EuroSCORE II, the logistic EuroSCORE with an European System for Cardiac Operative Risk Evaluation II (EuroSCORE) and the Society of Thoracic Surgeons score: implications for transcatheter value > _4% (increased surgical risk, according to the authors, Table 7. and table aortic valve implantation. Arch Cardiovasc Dis 2014;107:353–60. on page 631) needs further clariﬁcation and discussion. In particular, until re-  Leon M, Smith C, Mack M, Makkar R, Svensson L, Kodali S et al. cently, no threshold value has been proposed for the EuroSCORE II to deﬁne Transcatheter or surgical aortic-valve replacement in intermediate risk high-risk patients . To the best of our knowledge, Arangalage et al.  are the patients. N Eng J Med 2016;374:1609–20. only researchers who have searched for correspondence between borderline values of the Society of Thoracic Surgeons (STS) score and old logistic EuroSCORE for high-risk patients (> _10% and > _20%, respectively), which favour *Corresponding author. Clinic of Cardiac Surgery, Dedinje Cardiovascular Institute, TAVI, and for the EuroSCORE II. They proposed a threshold of > _7% for high-risk Milana Tepica 1, 11000 Belgrade, Serbia. Tel: +381-11-3601631/3601724; patients, which provided the best diagnostic value in their research cohort. In a fax: +381-11-2666392; e-mail: email@example.com (D. Nezic). subanalysis of our patients  undergoing SAVR (979 patients), 950 patients had a EuroSCORE II of <10%, and mortality was as low as 1.47% (14 of 950, doi:10.1093/ejcts/ezy121 The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Downloaded from https://academic.oup.com/ejcts/advance-article-abstract/doi/10.1093/ejcts/ezy121/4985708 by Ed 'DeepDyve' Gillespie user on 12 July 2018 LETTER TO THE EDITOR
European Journal of Cardio-Thoracic Surgery – Oxford University Press
Published: Apr 25, 2018
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