Reply to Nezic et al.

Reply to Nezic et al. European Journal of Cardio-Thoracic Surgery 0 (2018) 1 LETTER TO THE EDITOR RESPONSE interaction of individual risk factors, comorbidities, technical feasibility and ex- pected early and long-term outcomes that are specific for each procedure. In most trials, the lower cut-off for ‘intermediate risk’ was chosen to be 4% a,b, c Volkmar Falk * and Helmut Baumgartner by the Society of Thoracic Surgeons (STS) or EuroSCORE II. Patients with risk scores lower than this cut-off were largely excluded. Klinik fu ¨ r Herz-Thorax-Gefa ¨sschirurgie, Deutsches Herzzentrum Berlin, The task force was totally aware of the fact that this definition represents an Berlin, Germany arbitrary cut-off that is not supported by a large body of literature. In the ab- Klinik fu ¨ r Kardiovaskula ¨re Chirurgie, Charite, Berlin, Germany sence of a better stratification model, it was, however, decided to follow these Division of Adult Congenital and Valvular Heart Disease, Department of lines as evidence has accumulated around them. This does by no means imply Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany that every patient in the intermediate risk group with the EuroSCORE II of 4% or higher should be treated with TAVI by default. This is also clearly stated in Received 15 March 2018; accepted 18 March 2018 Table 7, which is designed to provide guidance for the decision-making pro- cess within the Heart Team. Keywords: Guidelines � Valve disease � Valve surgery � Percutaneous valve The authors refer to their own results in a group of patients with a mean intervention � Aortic regurgitation � Aortic stenosis � Mitral regurgitation � EuroSCORE II of 1.93%, representing a low-risk group of patients [2]. For this Mitral stenosis � Tricuspid regurgitation � Tricuspid stenosis � Prosthetic heart cohort, the guidelines clearly recommend surgery. The authors confirm this recommendation by their excellent surgical results. The observed mortality of valves 1.43% leads to a favourable O:E ratio of 0.74 and, hence, proves that guideline adherence provides excellent outcomes. The European Society of Cardiology/European Association for Cardio- Thoracic Surgery (ESC/EACTS) guidelines on valvular heart disease [1] provide guidance for the diagnostic workup for patients with aortic stenosis and give REFERENCES recommendations for appropriate treatment strategies. Since the last version of the guideline in 2012, a huge amount of new evidence has been generated with regard to the risks and benefits of surgical aortic valve replacement and [1] Falk V, Baumgartner H, Bax J, DeBonis M, Hamm C, Holm PJ et al. 2017 interventional transcatheter aortic valve implantation (TAVI) treatment for se- ESC/EACTS guidelines for the management of valvular heart disease. Eur vere aortic stenosis. J Cardiothorac Surg 2017;52:616–64. Although for inoperable patients and patients with high surgical risk TAVI [2] Nezic DG, Petrovic I, Micovic S. How have task force members deter- has evolved as the therapy of choice if no anatomical or technical criteria ren- mined the threshold value of EuroSCORE II for an increased surgical risk der a transcatheter approach impossible, for intermediate risk patients, the in patients undergoing aortic valve interventions? Eur J Cardiothorac available studies demonstrate equipoise with regard to the primary outcome. Surg 2018; doi:10.1093/ejcts/ezy121. It is made very clear in the guidelines that the decision to perform surgical aor- tic valve replacement or TAVI cannot be based on a single number such as age or the EuroSCORE alone. Rather, the decision relies on an iterative process that *Corresponding author. Klinik fu ¨ r Herz-Thorax-Gefa ¨sschirurgie, Deutsches takes all the factors into account that have a possible impact on the outcomes. Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Hence, the joint task force of ESC and EACTS tried to define an algorithm to ra- Tel: +49-30-45932000; fax: +49-30-45932100; e-mail: falk@dhzb.de (V. Falk). tionalize the use of either therapy in this particular patient cohort. In the centre of this algorithm stands the local heart team that has to address the complex doi:10.1093/ejcts/ezy147 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/ezy147/4985709 by Ed 'DeepDyve' Gillespie user on 12 July 2018 LETTER TO THE EDITOR http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

Reply to Nezic et al.

Free
1 page

Loading next page...
1 Page
 
/lp/ou_press/reply-to-nezic-et-al-RZvMp0RdVR
Publisher
Oxford University Press
Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
ISSN
1010-7940
eISSN
1873-734X
D.O.I.
10.1093/ejcts/ezy147
Publisher site
See Article on Publisher Site

Abstract

European Journal of Cardio-Thoracic Surgery 0 (2018) 1 LETTER TO THE EDITOR RESPONSE interaction of individual risk factors, comorbidities, technical feasibility and ex- pected early and long-term outcomes that are specific for each procedure. In most trials, the lower cut-off for ‘intermediate risk’ was chosen to be 4% a,b, c Volkmar Falk * and Helmut Baumgartner by the Society of Thoracic Surgeons (STS) or EuroSCORE II. Patients with risk scores lower than this cut-off were largely excluded. Klinik fu ¨ r Herz-Thorax-Gefa ¨sschirurgie, Deutsches Herzzentrum Berlin, The task force was totally aware of the fact that this definition represents an Berlin, Germany arbitrary cut-off that is not supported by a large body of literature. In the ab- Klinik fu ¨ r Kardiovaskula ¨re Chirurgie, Charite, Berlin, Germany sence of a better stratification model, it was, however, decided to follow these Division of Adult Congenital and Valvular Heart Disease, Department of lines as evidence has accumulated around them. This does by no means imply Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany that every patient in the intermediate risk group with the EuroSCORE II of 4% or higher should be treated with TAVI by default. This is also clearly stated in Received 15 March 2018; accepted 18 March 2018 Table 7, which is designed to provide guidance for the decision-making pro- cess within the Heart Team. Keywords: Guidelines � Valve disease � Valve surgery � Percutaneous valve The authors refer to their own results in a group of patients with a mean intervention � Aortic regurgitation � Aortic stenosis � Mitral regurgitation � EuroSCORE II of 1.93%, representing a low-risk group of patients [2]. For this Mitral stenosis � Tricuspid regurgitation � Tricuspid stenosis � Prosthetic heart cohort, the guidelines clearly recommend surgery. The authors confirm this recommendation by their excellent surgical results. The observed mortality of valves 1.43% leads to a favourable O:E ratio of 0.74 and, hence, proves that guideline adherence provides excellent outcomes. The European Society of Cardiology/European Association for Cardio- Thoracic Surgery (ESC/EACTS) guidelines on valvular heart disease [1] provide guidance for the diagnostic workup for patients with aortic stenosis and give REFERENCES recommendations for appropriate treatment strategies. Since the last version of the guideline in 2012, a huge amount of new evidence has been generated with regard to the risks and benefits of surgical aortic valve replacement and [1] Falk V, Baumgartner H, Bax J, DeBonis M, Hamm C, Holm PJ et al. 2017 interventional transcatheter aortic valve implantation (TAVI) treatment for se- ESC/EACTS guidelines for the management of valvular heart disease. Eur vere aortic stenosis. J Cardiothorac Surg 2017;52:616–64. Although for inoperable patients and patients with high surgical risk TAVI [2] Nezic DG, Petrovic I, Micovic S. How have task force members deter- has evolved as the therapy of choice if no anatomical or technical criteria ren- mined the threshold value of EuroSCORE II for an increased surgical risk der a transcatheter approach impossible, for intermediate risk patients, the in patients undergoing aortic valve interventions? Eur J Cardiothorac available studies demonstrate equipoise with regard to the primary outcome. Surg 2018; doi:10.1093/ejcts/ezy121. It is made very clear in the guidelines that the decision to perform surgical aor- tic valve replacement or TAVI cannot be based on a single number such as age or the EuroSCORE alone. Rather, the decision relies on an iterative process that *Corresponding author. Klinik fu ¨ r Herz-Thorax-Gefa ¨sschirurgie, Deutsches takes all the factors into account that have a possible impact on the outcomes. Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Hence, the joint task force of ESC and EACTS tried to define an algorithm to ra- Tel: +49-30-45932000; fax: +49-30-45932100; e-mail: falk@dhzb.de (V. Falk). tionalize the use of either therapy in this particular patient cohort. In the centre of this algorithm stands the local heart team that has to address the complex doi:10.1093/ejcts/ezy147 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/ezy147/4985709 by Ed 'DeepDyve' Gillespie user on 12 July 2018 LETTER TO THE EDITOR

Journal

European Journal of Cardio-Thoracic Surgery – Oxford University Press

Published: Apr 25, 2018

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.

Try 2 weeks free now

DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

or browse the journals available

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off

Sign up
for free
Start 14 day
Free Trial