Editorial comment
Editorial comment on “Aortic valve replacement for severe aortic stenosis in octogenarians: Patient outcomes and comparison of operative risk scores”
Comentário editorial ao artigo Aortic valve replacement for severe aortic stenosis in octogenarians: patient outcomes and operative risk score comparison
Pedro Canas da Silva
Hospital de Santa Maria, CHLN, Serviço de Cardiologia, Lisboa, Portugal
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on “Aortic valve replacement for severe aortic stenosis in octogenarians: Patient outcomes and comparison of operative risk scores”" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "447" "paginaFinal" => "448" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Pedro Canas da Silva" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Pedro" "apellidos" => "Canas da Silva" "email" => array:1 [ 0 => "pcanassilva@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital de Santa Maria, CHLN, Serviço de Cardiologia, Lisboa, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentário editorial ao artigo <span class="elsevierStyleItalic">Aortic valve replacement for severe aortic stenosis in octogenarians: patient outcomes and operative risk score comparison</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>, Tralhão et al. present a single-center case series over a seven-year period (January 2003 to December 2010) of 106 octogenarians undergoing surgical implantation of a biologic prosthetic aortic valve for symptomatic severe aortic stenosis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> Patients with associated valvular lesions or coronary artery disease requiring concomitant coronary artery bypass grafting were excluded. The aims of the study were to analyze outcomes in this population in terms of overall mortality and some of the complications often associated with this intervention, including stroke and need for pacemaker implantation or temporary hemodialysis, and to assess the predictive value of the scores most commonly used to determine operative risk in patients undergoing cardiac surgery: the logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE) I, EuroSCORE II and the Society of Thoracic Surgeons (STS) score.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Rates of mortality (5.7%), stroke (1.9%) and need for pacemaker implantation (4.7%) were similar to those in some of the most important published series,<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">4–9</span></a> which is unquestionably cause for satisfaction for the authors. It would be interesting to compare the results with those in a higher-risk population with more comorbidities, such as the study based on data of over 140<span class="elsevierStyleHsp" style=""></span>000 patients in the STS Adult Cardiac Surgery Database.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> However, the cutoff for the low risk category in the latter study was an STS score of 4%, with no standard deviation, and thus some patients could have been at lower risk than in the present study.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The study population was at low surgical risk according to the risk scores most commonly used for this purpose. This is partly due to the exclusion of patients with associated valvular lesions or coronary artery disease requiring surgery. Moreover, the median prosthesis ring size used was 21 mm, and smaller valves are known to be associated with worse prognosis.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Evaluation of the different risk scores showed good correlations for EuroSCORE II and the STS score, in both of which age is weighted less heavily than in EuroSCORE I.</p><p id="par0025" class="elsevierStylePara elsevierViewall">However, more importantly, these scores assess risk for early surgical mortality, but in this low-risk population, 30 days is too short. Other scores should be designed that better reflect the characteristics of these patients. As Tralhão et al. point out in their Discussion, new scores should be developed that take into consideration factors that are not currently included, such as porcelain aorta, severe respiratory failure requiring prolonged oxygen therapy, liver cirrhosis, chest deformation or previous radiation, immobility, dementia or dementia-like conditions, and frailty, although these can be difficult to define.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">8,9</span></a> It would also be helpful to include longer follow-up periods rather than immediate and 30-day only; for instance, time to recovery of normal activity, comparable to that before the intervention, is very important in a population with a short life expectancy.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> The development of alternatives that do not require sternotomy, and thus reduce hospital stays and associated morbidity, may change practice in the future.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">There is a clear need to improve the quality of risk scores for patients with aortic stenosis. The current scores accurately assess risk in most patients, but they do not cover certain situations that significantly increase risk or may actually contraindicate surgical aortic valve replacement.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Canas da Silva P. Comentário editorial ao artigo <span class="elsevierStyleItalic">Aortic valve replacement for severe aortic stenosis in octogenarians: patient outcomes and operative risk score comparison</span>. Rev Port Cardiol. 2015;34:447–448.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aortic valve replacement for severe aortic stenosis in octogenarians: patients outcomes and operative risk score comparison" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Tralhão" 1 => "R. Teles" 2 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 3 | 7 |
| 2024 October | 24 | 29 | 53 |
| 2024 September | 20 | 20 | 40 |
| 2024 August | 33 | 21 | 54 |
| 2024 July | 39 | 31 | 70 |
| 2024 June | 25 | 22 | 47 |
| 2024 May | 21 | 21 | 42 |
| 2024 April | 23 | 19 | 42 |
| 2024 March | 26 | 19 | 45 |
| 2024 February | 23 | 19 | 42 |
| 2024 January | 17 | 25 | 42 |
| 2023 December | 16 | 30 | 46 |
| 2023 November | 20 | 20 | 40 |
| 2023 October | 28 | 18 | 46 |
| 2023 September | 27 | 20 | 47 |
| 2023 August | 15 | 13 | 28 |
| 2023 July | 17 | 9 | 26 |
| 2023 June | 20 | 8 | 28 |
| 2023 May | 30 | 21 | 51 |
| 2023 April | 15 | 6 | 21 |
| 2023 March | 25 | 22 | 47 |
| 2023 February | 22 | 18 | 40 |
| 2023 January | 21 | 11 | 32 |
| 2022 December | 23 | 21 | 44 |
| 2022 November | 40 | 24 | 64 |
| 2022 October | 25 | 18 | 43 |
| 2022 September | 18 | 29 | 47 |
| 2022 August | 19 | 35 | 54 |
| 2022 July | 25 | 27 | 52 |
| 2022 June | 18 | 22 | 40 |
| 2022 May | 18 | 38 | 56 |
| 2022 April | 20 | 27 | 47 |
| 2022 March | 20 | 27 | 47 |
| 2022 February | 17 | 26 | 43 |
| 2022 January | 15 | 25 | 40 |
| 2021 December | 20 | 29 | 49 |
| 2021 November | 23 | 24 | 47 |
| 2021 October | 29 | 38 | 67 |
| 2021 September | 26 | 30 | 56 |
| 2021 August | 20 | 22 | 42 |
| 2021 July | 18 | 18 | 36 |
| 2021 June | 22 | 26 | 48 |
| 2021 May | 20 | 30 | 50 |
| 2021 April | 27 | 39 | 66 |
| 2021 March | 48 | 8 | 56 |
| 2021 February | 39 | 18 | 57 |
| 2021 January | 24 | 8 | 32 |
| 2020 December | 30 | 6 | 36 |
| 2020 November | 25 | 10 | 35 |
| 2020 October | 33 | 14 | 47 |
| 2020 September | 33 | 7 | 40 |
| 2020 August | 19 | 10 | 29 |
| 2020 July | 26 | 6 | 32 |
| 2020 June | 25 | 7 | 32 |
| 2020 May | 29 | 5 | 34 |
| 2020 April | 28 | 6 | 34 |
| 2020 March | 30 | 5 | 35 |
| 2020 February | 26 | 32 | 58 |
| 2020 January | 24 | 5 | 29 |
| 2019 December | 23 | 4 | 27 |
| 2019 November | 17 | 8 | 25 |
| 2019 October | 32 | 3 | 35 |
| 2019 September | 12 | 11 | 23 |
| 2019 August | 21 | 5 | 26 |
| 2019 July | 27 | 7 | 34 |
| 2019 June | 25 | 16 | 41 |
| 2019 May | 19 | 7 | 26 |
| 2019 April | 32 | 12 | 44 |
| 2019 March | 14 | 15 | 29 |
| 2019 February | 38 | 12 | 50 |
| 2019 January | 14 | 10 | 24 |
| 2018 December | 25 | 10 | 35 |
| 2018 November | 65 | 8 | 73 |
| 2018 October | 126 | 14 | 140 |
| 2018 September | 43 | 12 | 55 |
| 2018 August | 45 | 6 | 51 |
| 2018 July | 28 | 5 | 33 |
| 2018 June | 49 | 6 | 55 |
| 2018 May | 65 | 7 | 72 |
| 2018 April | 62 | 2 | 64 |
| 2018 March | 65 | 6 | 71 |
| 2018 February | 50 | 7 | 57 |
| 2018 January | 97 | 6 | 103 |
| 2017 December | 102 | 7 | 109 |
| 2017 November | 50 | 11 | 61 |
| 2017 October | 44 | 10 | 54 |
| 2017 September | 32 | 12 | 44 |
| 2017 August | 38 | 10 | 48 |
| 2017 July | 22 | 10 | 32 |
| 2017 June | 39 | 5 | 44 |
| 2017 May | 48 | 11 | 59 |
| 2017 April | 16 | 13 | 29 |
| 2017 March | 43 | 39 | 82 |
| 2017 February | 27 | 2 | 29 |
| 2017 January | 37 | 2 | 39 |
| 2016 December | 33 | 16 | 49 |
| 2016 November | 19 | 0 | 19 |
| 2016 October | 41 | 6 | 47 |
| 2016 September | 20 | 6 | 26 |
| 2016 August | 7 | 0 | 7 |
| 2016 July | 13 | 2 | 15 |
| 2016 June | 15 | 1 | 16 |
| 2016 May | 23 | 2 | 25 |
| 2016 April | 30 | 34 | 64 |
| 2016 March | 40 | 21 | 61 |
| 2016 February | 65 | 36 | 101 |
| 2016 January | 49 | 20 | 69 |
| 2015 December | 47 | 19 | 66 |
| 2015 November | 55 | 23 | 78 |
| 2015 October | 56 | 26 | 82 |
| 2015 September | 114 | 38 | 152 |
| 2015 August | 208 | 97 | 305 |
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