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How to cite: Robicsek F. (2007). In response to Wilhelmi MH, Bara C, Kofidis T, Wilhelmi M, Pichlmaier M, Haverich A. Long-term cardiac allograft valves after heart transplant are functionally and structurally preserved, in contrast to homografts and bioprostheses. The Journal of heart valve disease, 16(2), 214–215.

Bazin's disease was first reported in 1861, and is described as erythema induratum or nodular vasculitis. The condition is seen occasionally in middle-aged women on the skin of the calf, and a relationship to a tuberculosis infection has been proposed. In the present patient, valvular lesions occurred simultaneously with Bazin's disease, with granulomatous changes being demonstrated by the aortic valve pathology.

How to cite: Sughimoto, K., Nakano, K., Gomi, A., Nakatani, H., Nakamura, Y., Sato, A., Adachi, M., Takeda, K., & Harada, K. (2007). Aortic valve stenosis associated with Bazin's disease. The Journal of heart valve disease, 16(2), 212–213.

Cardiac hemangiomas are rare tumors, the presence of these neoplasms in heart valves is an exceptional finding, mainly because of their histological features. Normally, transesophageal echocardiography is used to establish a diagnosis of cardiac tumor, though careful interpretation is needed to avoid diagnostic errors. Herein is described an unusual presentation of a primary hemangioma of the mitral valve which was diagnosed as a prolapsing left atrial myxoma. The patient underwent successful surgical excision of the neoplasm, followed by mitral valve repair.

How to cite: Muzzi, L., Davoli, G., Specchia, L., & Chiavarelli, M. (2007). Primary hemangioma of the mitral valve: an unusual presentation. The Journal of heart valve disease, 16(2), 209–211.

Cardiac papillary fibroelastoma is a rare benign tumor which involves the heart valves and may cause thromboembolism or mechanical interference with valvular function. The case is presented of an asymptomatic, 22-year-old man in whom a fibroelastoma was localized on the ventricular aspect of the right coronary leaflet of the aortic valve. The tumor was identified during transthoracic echocardiography performed to monitor a mitral valve prolapse that had occurred at the age of 16 years. The patient underwent surgical intervention by means of a minimally invasive thoracotomy. The postoperative course was uneventful, and the patient was discharged on postoperative day 5. Due to the high incidence of embolism, the tumor must be surgically removed immediately a diagnosis is confirmed. A minimal surgical approach appears to be safe and allows good exposure of the lesion.

How to cite: Grande, A. M., Massetti, M., Castiglione, N., & Viganò, M. (2007). Valve-sparing removal of aortic fibroelastoma through ministernotomy. The Journal of heart valve disease, 16(2), 206–208.

Aerococcus urinae is a rarely reported pathogen that often causes mild urinary tract infection (UTI), although serious complications such as endocarditis and septicemia have also been described. The organism may easily be missed or misidentified when using commercial detection systems. A. urinae is resistant to sulfonamides and, therefore, a typical treatment for UTI may be inappropriate. To date, 14 cases of A. urinae infective endocarditis (IE) have been reported, most of which were elderly males with predisposing conditions to UTI. Of these patients, eight died and 50% of survivors had severe neurological problems. The case is reported of blood culture-negative IE in a 69-year-old male. The patient recovered fully after undergoing aortic valve replacement and receiving a nine-day course of intravenous ceftriaxone, followed by peroral cefuroxime for the next 11 weeks. The causative agent was identified from the excised valve by bacterial broad-range PCR and direct sequencing of the 16S rRNA gene.

How to cite: Slany, M., Freiberger, T., Pavlik, P., & Cerny, J. (2007). Culture-negative infective endocarditis caused by Aerococcus urinae. The Journal of heart valve disease, 16(2), 203–205.

Warfarin, an oral anticoagulant, is the therapy of choice to maintain anticoagulation. An individual requiring five- to 20-fold higher dosage than average for anticoagulation may be considered as having resistance to warfarin. In order to evaluate a subtherapeutic response to high-dose warfarin, the clinician must consider many possible causes of resistance, such as non-compliance, drug interactions, or pharmacokinetic changes. When these factors have been eliminated, an hereditary warfarin resistance might be considered responsible. The case is reported of a 49-year-old woman who received warfarin after mitral valve replacement and experienced mechanical mitral valve thrombosis due to inadequate anticoagulation, possibly caused by warfarin resistance.

How to cite: Yasar, A. S., Balbay, Y., Maden, O., & Sasmaz, H. (2007). Early mechanical mitral valve thrombosis in a patient with warfarin resistance. The Journal of heart valve disease, 16(2), 200–202.

Background and aim of the study: Undersized mitral annuloplasty (MAP) is effective in patients with dilated cardiomyopathy and functional mitral regurgitation (MR) since, as well as addressing the MR, the MAP may also reshape the dilated left ventricular (LV) base. However, the direct benefits of this possible reshaping on LV function in the absence of underlying MR remain incompletely understood. The study aim was to identify these benefits in a canine model of acute heart failure.

Methods: Six dogs underwent MAP with a prosthetic band on the posterior mitral annulus, using four mattress sutures. The sutures were passed individually through four tourniquets and exteriorized untied via the left atriotomy. Sonomicrometry crystals were implanted around the mitral annulus and left ventricle to measure geometry and regional function. Acute heart failure was induced by propranolol and volume loading after weaning from cardiopulmonary bypass; an absence of MR was confirmed by echocardiography. MAP was accomplished by cinching the tourniquets. Data were acquired at baseline, after induction of acute heart failure, and after MAP.

Results: MAP decreased mitral annular dimensions in both commissure-commissure and septal-lateral directions. Concomitantly, the diastolic diameter of the LV base and LV sphericity decreased (i.e., improved) from 37.4 +/- 9.3 to 35.9 +/- 10 mm (p = 0.063), and from 67.9 +/- 18.6% to 65.3 +/- 18.9% (p = 0.016), respectively. Decreases were evident in both LV end-diastolic pressure (from 17 +/- 7 to 15 +/- 6 mmHg, p = 0.0480 and Tau (from 48 +/- 8 to 45 +/- 8 ms, p <0.01), while fractional shortening at the LV base increased from 7.7 +/- 4.5% to 9.4 +/- 4.5% (p = 0.045). After MAP, increases were identified in both cardiac output (from 1.54 +/- 0.57 to 1.65 +/- 0.57 1/min) and Emax (from 1.86 +/- 0.9 to 2.41 +/- 1.31 mmHg/ml).

Conclusion: The data acquired suggest that isolated MAP may have certain benefits on LV dimension/function in acute heart failure, even in the absence of MR. However, further investigations are warranted in a model of chronic heart failure.

How to cite: Koyama, T., Soga, Y., Unimonh, O., Nishimura, K., & Komeda, M. (2007). Mitral annuloplasty as a ventricular restoration method for the failing left ventricle: a pilot study. The Journal of heart valve disease, 16(2), 195–199.

Background and aim of the study: Heart valve surgery in high-risk patients is associated with considerable morbidity and mortality. Epidural anesthesia without mechanical ventilation has been proposed to reduce invasiveness. An analysis was conducted in very high-risk heart valve patients of mid-term survival free from complications, and patient satisfaction of regional anesthesia use, without mechanical ventilation.

Methods: A prospective follow up study was conducted in 50 patients (24 females, 26 males; mean age 74 +/- 10 years; range: 43-89 years) who underwent heart valve surgery with epidural anesthesia without endotracheal intubation. Preoperatively, all patients were in NYHA class III or IV; eight patients (16%) had undergone a previous cardiac procedure. The median Additive and Logistic EuroSCORE were 14.5 and 52%, respectively. Twenty-seven patients underwent aortic valve replacement, 10 mitral valve replacement, 10 mitral valve repair, two double valve replacement, and one patient ascending aorta replacement. Associated surgical procedures included coronary artery bypass grafting in 12 patients (24%), ascending aorta replacement in three (6%), and left ventricle reshaping in two (4%). Radiofrequency ablation to treat chronic atrial fibrillation (AF) was performed in 15 patients (30%). All patients were prospectively followed up, and a six-month quality of life assessment was performed in all survivors.

Results: Procedures were performed without mechanical ventilation in completely awake and conscious patients. There were two in-hospital and two long-term deaths (8%). Three patients had had previous cardiac surgery (two double valve replacements, two complex mitral valve surgery). Among survivors, 34 (71%) had an uneventful postoperative outcome, except for AF in nine cases. Eight patients required revision for bleeding; two of these were redo cases. The most consistent postoperative complication was acute renal failure in 16 patients, five of whom had previous chronic renal failure. Three patients required mechanical ventilatory support, and none had a cerebrovascular accident. Patients were discharged home after a mean of 10 +/- 5 days (including ICU stay; median 9 h). At follow up, all patients were in NYHA class I/II, and all survivors expressed their satisfaction with epidural anesthesia.

Conclusion: Heart valve surgery while on cardiopulmonary bypass is feasible and safe using epidural anesthesia. By maintaining autonomic ventilation, a low mid-term morbidity and mortality was observed in patients in whom there was an unacceptable operative risk.

How to cite: Bottio, T., Bisleri, G., Piccoli, P., Negri, A., Manzato, A., & Muneretto, C. (2007). Heart valve surgery in a very high-risk population: a preliminary experience in awake patients. The Journal of heart valve disease, 16(2), 187–194.

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How to cite: Executive summary: Prevention of thromboembolic events: the role of point of care management. (2007). The Journal of heart valve disease, 16(2), 184–186.

Background and aim of the study: Substantial heart valve research relies on the isolation of valvular interstitial cells (VICs). While a wide variety of conditions have been reported for VIC isolation, the effectiveness of these methods has rarely been compared. It is also likely that valve donor age will influence these valvular tissue dissociation conditions. The study aim was to increase the efficiency and cost-effectiveness of VIC isolation, while taking into account possible differences due to valve donor age.

Methods: Aortic valves were obtained from six-month-old (n = 24) and six-week-old (suckling) pigs (n = 45) within 24 h of death. After removal of endothelial cells, the tissues were minced and subjected to a variety of enzymatic digestions for variable lengths of time.

Results: The optimal concentration of collagenase III was determined as 1 mg/ml for six-week-old pigs, and 2 mg/ml for six-month-old pigs. The optimal duration of digestion was 4 h for both ages. The addition of neutral protease (2 mg/ml) further increased yield, while additional DNAse and hyaluronidase had no effect. Yield was not influenced by the volume of enzyme solution, nor the use of previously frozen enzyme solution.

Conclusion: These findings provide age-specific conditions for improving the yield of VIC isolation, which should be of value in experimental studies of valvular cell biology and tissue engineering investigations.

How to cite: Stephens, E. H., Carroll, J. L., & Grande-Allen, K. J. (2007). The use of collagenase III for the isolation of porcine aortic valvular interstitial cells: rationale and optimization. The Journal of heart valve disease, 16(2), 175–183.

Background and aim of the study: Although bovine pericardium has been used extensively in cardiothoracic surgery, its degeneration and calcification are important limiting factors in the continued use of this material. The study aims were to decellularize bovine pericardium and to compare the biomechanical properties of fresh and decellularized bovine pericardia to those treated with different concentrations of glutaraldehyde (GA).

Methods: An established protocol for decellularization using sodium dodecyl sulfate was used, and histological analysis performed to validate the adequacy of decellularization. Contact cytotoxicity was used to study the in-vitro biocompatibility of variously treated pericardia. Mechanical testing involved uniaxial testing to failure. Mechanical properties of the fresh and decellularized pericardia (untreated and treated with 0.5% and 0.05% GA) were compared.

Results: Histological analysis of decellularized bovine pericardium did not show any remaining cells or cell fragments. The histoarchitecture of the collagen-elastin matrix appeared well preserved. Untreated decellularized pericardium was biocompatible in contact cytotoxicity tests with smooth muscle and fibroblast cells. The GA-treated tissue was cytotoxic. There were no significant differences in the mechanical properties of fresh and decellularized pericardia, but there was an overall tendency for GA-treated pericardia to be stiffer than their untreated counterparts.

Conclusion: An acellular matrix, cross-linked with a reduced concentration of GA, can be produced using bovine pericardium. This biomaterial has excellent biomechanical properties and, potentially, may be used in the manufacture of heart valves and pericardial patches for clinical application.

How to cite: Oswal, D., Korossis, S., Mirsadraee, S., Wilcox, H., Watterson, K., Fisher, J., & Ingham, E. (2007). Biomechanical characterization of decellularized and cross-linked bovine pericardium. The Journal of heart valve disease, 16(2), 165–174.

A 37-year-old patient presented with severe aortic valve insufficiency due to massive dilatation of the neo-aortic root (77 mm diameter) 14 years after a Ross procedure. Intraoperatively, the dilatation appeared to be caused by a localized chronic dissection of the pulmonary autograft. Surgery consisted of a modified Bentall procedure with a mechanical composite valve, with an uncomplicated postoperative course.

How to cite: Kaya, A., Heijmen, R. H., Vreuls, W., Seldenrijk, C. A., & Schepens, M. A. (2007). Chronic type A dissection in a pulmonary autograft. The Journal of heart valve disease, 16(2), 162–164.

Reiter's syndrome is characterized by multiple joint arthropathy, and can affect the heart. One manifestation of cardiac involvement is aortic insufficiency that may require valve replacement. Herein is reported a case with rapidly progressive and severe calcification of a bovine pericardial prosthesis seven years after implantation, in the setting of Reiter's syndrome. Based on this experience, it is suggested that echocardiographic evaluations be scheduled more frequently than usual if a bioprosthetic rather than mechanical valve is chosen for a patient with Reiter's syndrome.

How to cite: Howard, J. H., Litovsky, S. H., Tallaj, J. A., Liu, X., & Holman, W. L. (2007). Xenograft calcification in Reiter's syndrome. The Journal of heart valve disease, 16(2), 159–161.

Background and aim of the study: The clinical performance of mechanical heart valves and valve-related complications are important safety endpoints in patients after heart valve replacement. In this retrospective analysis, the mid- to long-term clinical outcomes of two similar bileaflet heart valves, routinely implanted at the authors' institution over an 11-year period, were compared.

Methods: Between January 1993 and December 2003, a total of 1,161 patients (758 males, 403 females) received either a St. Jude Medical (SJM) or ATS mechanical heart valve. Follow up was obtained via an in-house Quality Management Database, ascertained by telephone questionnaire of the patients and/or family physicians. Follow up was 98.9% complete; the median follow up was 4.6 years; total follow up was 5,624 patient-years (pt-yr).

Results: A total of 604 SJM and 601 ATS prostheses was implanted as isolated (n = 669) or combined (n = 492) procedures. The overall 30-day mortality for SJM and ATS was 4.1% and 3.4%, respectively (p = 0.45). Cumulative survival and freedom from valve-related mortality at 10 years for SJM and ATS valves were 66 +/- 3% versus 68 +/- 5% (p = 0.84) and 96 +/- 1% versus 97 +/- 1% (p = 0.36), respectively. No structural valve failure was encountered for both valve types. Freedom from overall valve-related complications at 10 years was 79 +/- 4% for SJM and 66 +/- 6% for ATS (p = 0.08). The linearized rates for valve-related adverse events for SJM and ATS valves, respectively, were: thromboembolism 0.9 and 1.1%/pt-yr; major bleeding requiring transfusion 0.3 and 0.5%/pt-yr; prosthetic endocarditis 0.03 and 0.1%/pt-yr; paravalvular leak 0.1 and 0.6%/pt-yr.

Conclusion: On the basis of an 11-year experience, both bileaflet valves showed very good clinical results, with low incidences of adverse events during the mid-term outcome. Gender and/or concomitant coronary artery disease were not predictors for reduced life expectancy.

How to cite: Bernet, F. H., Baykut, D., Grize, L., & Zerkowski, H. R. (2007). Single-center outcome analysis of 1,161 patients with St. Jude medical and ATS open pivot mechanical heart valves. The Journal of heart valve disease, 16(2), 151–158.

Quadricuspid aortic valve in adulthood is a rare pathology which often leads to aortic valve regurgitation that requires surgical treatment. Herein are described two patients with severe regurgitation on a quadricuspid aortic valve and with dilated left ventricle, who where successfully repaired using a technique of tricuspidation of the valve at the level of the abnormal commissure. In each patient, the repair was stabilized and leaflet coaptation increased by subcommissural annuloplasty stitches at the level of the three commissures. After one year and six months' follow up, respectively, both patients presented with trivial aortic regurgitation and good mobility of the three leaflets.

How to cite: Jeanmart, H., de Kerchove, L., El Bitar, F., Glineur, D., Vandyck, M., Noirhomme, P., & El Khoury, G. (2007). Tricuspidation of quadricuspid aortic valve: case reports. The Journal of heart valve disease, 16(2), 148–150.

In aortic valve-sparing surgery, the native valve of the patient is left in place but may need correction of its dimensions in order to regain full competence. A sizer was designed that can simultaneously measure the leaflet height and free edge length. A prototype was built and successfully used in porcine hearts of various sizes. The sizer is easy to use and provides dependable measurement of the aortic leaflet dimensions. Moreover, it represents a new resource on which surgeons may draw on to perform aortic valve-sparing surgery, with a better outcome for the patients.

How to cite: Labrosse, M. R., & Beller, C. J. (2007). Aortic valve leaflet sizer: a new device for aortic valve sparing. The Journal of heart valve disease, 16(2), 145–147.

Background and aim of the study: Today, ageing of the western population is causing aortic valve surgery to be performed in elderly patients with increasing frequency. The study aim was to evaluate surgical outcome in octogenarian patients undergoing aortic valve replacement (AVR).

Methods: A total of 100 patients (mean age 82.1 +/- 2.7 years; range: 80-95 years) who underwent AVR over a three-year period was reviewed. Concomitant coronary artery bypass grafting was performed in 34% of cases, and a bioprosthesis was implanted in 80%. The mean logistic EuroSCORE was 13.3%.

Results: Operative mortality was 8.0%. In multivariate analysis, a logistic EuroSCORE > or =13.5% (p = 0.02), cross-clamp time > or =75 min (p = 0.02) and postoperative acute renal failure were predictors for in-hospital mortality. Follow up was 100% complete; the mean follow up period was 10.6 months. At one year after surgery, the actuarial survival rate of those patients who survived surgery was 86.1%. Postoperative dyspnea at one month (p = 0.004) was the only predictor of short-term mortality.

Conclusion: Age in itself should not contraindicate surgery, and healthcare systems should be prepared to accommodate elderly patients who may require special resources.

How to cite: Urso, S., Sadaba, R., Greco, E., Pulitani, I., Alvarez, L., Juaristi, A., & Goiti, J. J. (2007). One-hundred aortic valve replacements in octogenarians: outcomes and risk factors for early mortality. The Journal of heart valve disease, 16(2), 139–144.

Ventricular rupture is a dreaded complication of mitral valve replacement. Herein are reported two cases of late left ventricular rupture following mitral valve replacement at 10 and 48 days, respectively, after the initial surgery. Both ventricular ruptures were successfully repaired, one through an internal and one an external approach.

How to cite: Digonnet, A., Flecher, E., Aubert, S., & Pavie, A. (2007). Successful repair of late left ventricular rupture after mitral valve replacement. The Journal of heart valve disease, 16(2), 136–138.

Hemolytic anemia due to a periprosthetic leak is a rare complication of valve replacement that has a poor prognosis. Herein are reported the details of two women (aged 62 and 74 years) who had undergone mitral valve surgery four times each; in both cases, a fifth operation was performed because of hemolytic anemia due to periprosthetic leak. An anterior repair of the leaks was performed instead of re-replacing the valve or standard repair, because the extensively calcified annulus led to sufficient space, and viable tissue was available to place direct sutures. Both patients made a rapid and uneventful recovery, with satisfactory short-term results; however, the long-term outcomes remain uncertain.

How to cite: Sakamoto, Y., Hashimoto, K., Okuyama, H., Ishii, S., Taguchi, S., Kagawa, H., & Morita, K. (2007). Repair of mitral periprosthetic leak secondary to severe annular calcification. The Journal of heart valve disease, 16(2), 132–135.

Background and aim of the study: The study aim was to evaluate the efficacy of left atrial (LA) size reduction combined with radiofrequency (RF) ablation in the treatment of continuous atrial fibrillation (AF), by comparative analysis of the outcomes of patients undergoing RF ablation with and without LA size reduction.

Methods: A total of 46 patients with continuous AF and cardiac disease underwent cardiac surgery and RF ablation alone (group I, n = 20) or combined with LA size reduction (group II, n = 26). Patients were followed for three years postoperatively, with evaluation of cardiac rhythm, neurological complications, LA size (by echocardiography) and atrial contractility.

Results: At three years after surgery, sinus rhythm (SR) was restored in 61.1% and 70% of patients in groups I and II, respectively. Mean LA diameter was reduced from 60 +/- 15 mm to 57 +/- 5 mm in group I, and from 69 +/- 19 mm to 55 +/- 6 mm in group II. The overall three-year survival was 90% in group I, and 88.5% in group II. Three-year freedom from stroke was 88.9% and 86.2% in groups I and II, respectively. Two patients in each group received transvenous permanent pacemaker implantation. Atrial contractility was recovered in all patients with stable SR.

Conclusion: LA size reduction improves SR conversion rate after RF ablation for continuous AF in patients undergoing concomitant cardiac surgery.

How to cite: Scherer, M., Therapidis, P., Wittlinger, T., Miskovic, A., & Moritz, A. (2007). Impact of left atrial size reduction and endocardial radiofrequency ablation on continuous atrial fibrillation in patients undergoing concomitant cardiac surgery: three-year results. The Journal of heart valve disease, 16(2), 126–131.

With the increasing survival of heart transplant recipients, the risk for acquired allograft disease will be augmented. Severe mitral valve insufficiency after heart transplantation is rarely described. Similar to the general population, a degenerative process may affect the allograft mitral valve. Herein are reported two cases of severe mitral valve degeneration necessitating mitral valve replacement long term after heart transplantation. The pathophysiology and operative strategy for these patients are discussed.

How to cite: Mohammadi, S., Dagenais, F., Sénéchal, M., LeBlanc, M. H., Couture, C., Voisine, P., & Doyle, D. (2007). Degenerative mitral valve insufficiency long term after heart transplantation: clinical and surgical considerations. The Journal of heart valve disease, 16(2), 122–125.

Background and aim of the study: The European system for cardiac operative risk evaluation score (EuroSCORE) has been shown to be a valid tool for predicting immediate and late outcome after coronary artery bypass surgery. As evidence also suggests its value in heart valve surgery, this issue was investigated in a series of patients who underwent surgery for mitral valve regurgitation.

Methods: Data obtained from 180 patients who underwent mitral valve repair (MVRep) or mitral valve replacement (MVR) were reviewed, and the patients' additive and logistic EuroSCOREs calculated.

Results: The 30-day postoperative mortality rate was 10.0% (n = 18); rates were 7.1% after MVRep and 20.5% after MVR (p = 0.013). The additive EuroSCORE (p <0.0001, area under the ROC curve: 0.804, 95% CI 0.689-0.919, SE 0.059), as well as logistic EuroSCORE (p <0.0001, area under the ROC curve: 0.806, 95% CI 0.695-0.918, SE 0.057) were predictors of 30-day postoperative death. The 10-year overall survival rate from any cause of death was 74.7%. Additive and logistic EuroSCOREs were significantly higher in the MVR group compared to the MVRep group (p <0.0001 in both cases), and also among operative survivors. Patients who underwent MVR had a significantly poorer long-term survival than those with MVRep (p = 0.01). Both the additive EuroSCORE (p <0.0001) and logistic EuroSCORE (p = 0.003) were predictors of late, all-cause mortality. Both scores remained significant predictors of late outcome also when adjusted for type of surgery (MVRep versus MVR). Survival was particularly dismal in patients with an additive EuroSCORE >6 (at 10 years, 54.4% versus 86.6%, p <0.00001) or a logistic EuroSCORE >4% (at 10 years, 58.7% versus 86.6%, p <0.00001).

Conclusion: EuroSCORE is an important predictor of immediate and late outcome after surgery for mitral valve regurgitation.

How to cite: Heikkinen, J., Biancari, F., Satta, J., Salmela, E., Mosorin, M., Juvonen, T., & Lepojärvi, M. (2007). Predicting immediate and late outcome after surgery for mitral valve regurgitation with EuroSCORE. The Journal of heart valve disease, 16(2), 116–121.

Background and aim of the study: The study aim was to construct a simple model (the Fuwai risk score) to predict prolonged intensive care unit (ICU) stay after surgery to treat acquired heart valve disease.

Methods: Data were collected retrospectively from 2,218 consecutive patients who underwent surgery for acquired heart valve disease. Prolonged ICU stay was defined as > or =5 days. A simple logistic score was calculated using the logistic coefficient, and the additive score by odds ratio. The Fuwai risk score, EuroSCORE and Parsonnet score were applied to predict a prolonged ICU stay and mortality. A C statistic (receiver operating characteristic curve) was used to test discrimination of the models. Calibration was assessed with a Hosmer-Lemeshow goodness-of-fit statistic.

Results: The simple logistic model of the Fuwai risk score showed very good discriminatory ability (C statistic 0.76) and calibration (Hosmer-Lemeshow, p = 0.25) in predicting prolonged ICU stay, while the additive algorithm had good discriminatory ability (C statistic 0.75) but poor calibration (p <0.001). The additive algorithm greatly underestimated the risk for high-risk patients. The Fuwai risk score showed good discriminatory ability, but poor calibration in predicting mortality. Neither the EuroSCORE nor Parsonnet score was superior to the Fuwai risk score.

Conclusion: The logistic algorithm of the Fuwai risk score is a simple, objective, convenient and accurate scoring system which may be used to predict prolonged ICU stay after surgery to treat acquired heart valve disease.

How to cite: Xu, J., Ge, Y., Hu, S., Song, Y., Sun, H., & Liu, P. (2007). A simple predictive model of prolonged intensive care unit stay after surgery for acquired heart valve disease. The Journal of heart valve disease, 16(2), 109–115.

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How to cite: Nashef S. A. (2007). Risk modelling for heart valve disease. The Journal of heart valve disease, 16(2), 107–108.