OBJECTIVES: (i) To establish who is at high risk for mitral surgery. (ii) To assess the performance of minimally invasive mitral valve surgery in high-risk patients by presenting early and late outcomes and compare these with those of the non-high-risk population. METHODS: We reviewed our database of prospective data of 1873 consecutive patients who underwent minimally invasive mitral surgery from 2003 to 2015. To establish an unbiased definition of risk cut-off, we considered as high-risk the 'outliers of risk' identified using boxplot analysis in relation to EuroSCORE II. RESULTS: Two hundred and five patients were outliers, with 98 as minor (EuroSCORE II >= 6%) and 107 as major outliers (EuroSCORE II >= 9%). Outliers accounted for several different comorbidities. Nineteen patients died while in hospital (9.2%); different postoperative complications were observed. Outliers had a significantly lower mean survival time and a higher risk of cardiac-related death than the general population; however, the worst outcomes were observed in major outliers. No statistically significant difference was found with regard to the need for mitral reintervention and the degree of mitral regurgitation at follow-up. CONCLUSIONS: Boxplot analysis helped to achieve an internal definition of risk cut-off, starting from EuroSCORE II >= 6%. Minimally invasive mitral surgery in these outliers of risk was associated with acceptable early and long-term results; however, major outliers with EuroSCORE II >= 9% may benefit from catheter-based procedures.

Minimally invasive mitral valve surgery in high-risk patients: operating outside the boxplot / Moscarelli M; Cerillo A; Athanasiou T; Farneti P; Bianchi G; Margaryan R; Solinas M. - In: INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY. - ISSN 1569-9293. - 22:(2016), pp. 756-761. [10.1093/icvts/ivw038]

Minimally invasive mitral valve surgery in high-risk patients: operating outside the boxplot

Cerillo A;
2016

Abstract

OBJECTIVES: (i) To establish who is at high risk for mitral surgery. (ii) To assess the performance of minimally invasive mitral valve surgery in high-risk patients by presenting early and late outcomes and compare these with those of the non-high-risk population. METHODS: We reviewed our database of prospective data of 1873 consecutive patients who underwent minimally invasive mitral surgery from 2003 to 2015. To establish an unbiased definition of risk cut-off, we considered as high-risk the 'outliers of risk' identified using boxplot analysis in relation to EuroSCORE II. RESULTS: Two hundred and five patients were outliers, with 98 as minor (EuroSCORE II >= 6%) and 107 as major outliers (EuroSCORE II >= 9%). Outliers accounted for several different comorbidities. Nineteen patients died while in hospital (9.2%); different postoperative complications were observed. Outliers had a significantly lower mean survival time and a higher risk of cardiac-related death than the general population; however, the worst outcomes were observed in major outliers. No statistically significant difference was found with regard to the need for mitral reintervention and the degree of mitral regurgitation at follow-up. CONCLUSIONS: Boxplot analysis helped to achieve an internal definition of risk cut-off, starting from EuroSCORE II >= 6%. Minimally invasive mitral surgery in these outliers of risk was associated with acceptable early and long-term results; however, major outliers with EuroSCORE II >= 9% may benefit from catheter-based procedures.
2016
22
756
761
Moscarelli M; Cerillo A; Athanasiou T; Farneti P; Bianchi G; Margaryan R; Solinas M
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1404234
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