Shahab Nozohoor - Academia.edu (original) (raw)

Papers by Shahab Nozohoor

Therapeutic hypothermia and temperature management, Jan 29, 2015

The safety, feasibility, and hemodynamic effects of mild hypothermia (MH) induced by transnasal c... more The safety, feasibility, and hemodynamic effects of mild hypothermia (MH) induced by transnasal cooling were studied in transcatheter aortic valve replacement (TAVR). MH is a common therapy following cardiac arrest and seems to have favorable effects in myocardial infarction and on hemodynamic stability. In TAVR, hemodynamic instability is common during rapid pacing. Twenty subjects undergoing TAVR were randomized 1:1 to hypothermia or normothermia. Hemodynamic endpoints were mean arterial blood pressure and required dosage of vasoactive and inotropic drugs. Patients were followed up at 6 months. All patients in the MH group (n=10) reached the target temperature of 34°C before first rapid pacing. Tympanic and urinary bladder temperature remained significantly lower in the MH group during the procedure. No adverse effects of cooling were observed. Mean arterial pressure was higher in the MH group (90±20 mm Hg) than in the control group (71±13 mm Hg) at the start of the procedure, at ...

The Journal of heart valve disease

Increased life expectancy and improvement in clinical outcome following surgery has led to an inc... more Increased life expectancy and improvement in clinical outcome following surgery has led to an increasing number of elderly patients with a history of prior aortic valve replacement (AVR). As a consequence, a considerable number of patients may require reintervention due to a dysfunctional bioprosthesis with structural valve deterioration (SVD). Transcatheter aortic valve implantation (TAVI) has become an established surgical alternative in patients with aortic stenosis and severe comorbidities. For those patients requiring reoperation, the 'valve-in-valve' concept has been described. Here, the case is reported of a patient with a very small Sorin Soprano 18 bioprosthesis with SVD who underwent a reintervention with the transapical valve-in-valve technique. The implantation was uneventful, with no residual paravalvular leakage and a low mean transprosthetic gradient. The valve-in-valve procedure may represent a feasible alternative for redo AVR in patients with a very small, ...

Journal of Cardiac Surgery, 2015

Surgery is performed in up to half of all cases of active infective endocarditis (IE) but the ass... more Surgery is performed in up to half of all cases of active infective endocarditis (IE) but the associated mortality remains high. The aim was to examine the effect of the preoperative clinical presentation on long-term survival of patients undergoing surgery for isolated native mitral valve infective endocarditis. A retrospective study was conducted on 100 patients who had undergone mitral valve surgery from 1998 to 2014 for ongoing isolated, native valve IE. Patients were stratified depending on preoperative symptoms: clinical stroke due to septic cerebral embolism, congestive heart failure, and uncontrolled bacteremia. Group A had none of the clinical symptoms, Group B had one of the above clinical symptoms, and Group C had ≥2 symptoms. Follow-up was 100% complete for survival (median 3.8 years, IQR 0.8-7.7). Event rates were estimated with the Kaplan-Meier method and Cox-regression was performed. Overall 30-day mortality was 5% (n = 5); 0% in Group A; 8% in Group B (n = 4); and 8% in Group C (n = 1), p = 0.24. Five-year survival was 87.0 ± 6.1% in Group A, 62.6 ± 7.1% in Group B, and 33.8 ± 15.2% in Group C. Grouping by clinical presentation was found to be an independent predictor of mortality (Group B, HR 2.37, 95% CI 1.02-5.50; Group C, HR 4.07, 95% CI 1.56-10.6). Long-term survival after surgery for native mitral valve IE was independently influenced by the presence of preoperative embolic stroke, congestive heart failure or uncontrolled bacteremia alone, or in combination.

The Journal of heart valve disease, 2013

Left atrial (LA) enlargement is a pathophysiological response to volume overload resulting from c... more Left atrial (LA) enlargement is a pathophysiological response to volume overload resulting from chronic mitral regurgitation (MR), is known as LA remodeling, and has been shown previously to be associated with cardioembolic events. Following mitral valve surgery (MVS), the left atrium may undergo reverse remodeling characterized by LA volume reduction. The study aim was to evaluate the incidence and determinants of postoperative left atrial reverse remodeling (LARR) following MVS. The postoperative left atrial volume index (LAVi) was determined echocardiographically in patients with degenerative chronic MR undergoing isolated MVS (n = 110), using three different algorithms, and compared to the preoperative values. LARR was defined as a reduction in LAVi > or = 15%. The postoperative mean LA diameter (p < 0.001), LA area (p < 0.001), and LAVi (p < 0.001) were each decreased significantly. LARR was observed in 84 patients (76%), with a mean postoperative LAVi reduction of ...

The Journal of heart valve disease, 2007

The study aim was to analyze the relationship between patient-prosthesis mismatch (PPM) and in-ho... more The study aim was to analyze the relationship between patient-prosthesis mismatch (PPM) and in-hospital complications and mortality after aortic valve replacement (AVR). AVR was performed in 1,819 patients between January 1996 and July 2006. Follow up investigations were performed after a mean of 4.3 years (range: 0 days to 10.6 years). Univariate and multivariate analysis were used to evaluate risk factors for in-hospital complications and mortality in patients with prosthesis mismatch. Actuarial statistics were used to calculate survival rates. Multivariate analysis showed that PPM (defined as indexed effective orifice area < or = 0.85 cm2/m2) was associated with an increased risk of postoperative neurological events (OR 2.26, 95% CI 1.05-4.83, p = 0.037). There were no significant differences in 30-day mortality between the PPM and non-PPM groups. Neither was any significant difference found between the two groups regarding long-term survival adjusted for significant risk fact...

Interactive CardioVascular and Thoracic Surgery, 2011

The Annals of Thoracic Surgery, 2014

Our aim was to assess right ventricular (RV) performance after mitral valve repair by use of RV f... more Our aim was to assess right ventricular (RV) performance after mitral valve repair by use of RV focused echocardiography and to evaluate the influence of elevated pulmonary artery systolic pressure (PASP) on RV recovery. Forty consecutive patients undergoing mitral valve repair were prospectively investigated with RV focused echocardiography, including two-dimensional speckle tracking-derived longitudinal strain and measurement of N-terminal protype-B natriuretic peptide levels performed on the day before operation and 6 months postoperatively. The 30-day mortality was 0%. Overall survival was 97.5% ± 2.5% at 6-month follow-up, and the prevalence of postoperative RV dysfunction was 61% (n = 22). Conventional longitudinal indices of RV function decreased significantly after operation (n = 36): tricuspid annular plane systolic excursion (mean 24 ± 5 mm vs mean 15 ± 3 mm, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), systolic peak velocity (mean 14 ± 3 cm/s vs mean 10 ± 2 cm/s, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), isovolumic acceleration time (mean 2.5 ± 1.0 cm/s(2) vs mean 2.1 ± 0.7 cm/s(2), p = 0.022), but the RV free wall, septal, and global strain did not change significantly. Patients with preoperative PASP above 50 mm Hg showed a significant change in postoperative RV global strain compared with those whose PASP was 50 mm Hg or below (mean difference 10% ± 30% vs -17% ± 23%, p = 0.033). RV dysfunction was common at 6-month follow-up. Pulmonary hypertension, although reversible after operation, had a negative effect on RV function. Speckle tracking-derived RV strain may assist in the prioritization of surgical referrals to avoid biventricular impairment.

Interactive cardiovascular and thoracic surgery, 2014

Resection techniques are the established method for posterior mitral valve leaflet repair in dege... more Resection techniques are the established method for posterior mitral valve leaflet repair in degenerative mitral valve disease. However, implantation of expanded polytetrafluoroethylene (ePTFE) neochordae is gaining acceptance. The aim of this study was to compare the durability and clinical outcome following mitral valve repair using ePTFE neochordae or leaflet resection. A retrospective study was conducted of 224 patients who had undergone isolated mitral valve repair for degenerative posterior mitral leaflet prolapse from 1998 to 2012 at two cardiothoracic centres, one in Sweden and one in Denmark. Follow-up was performed in February 2013 and was 100% complete for survival (1184 patient-years; mean 5.9 ± 3.9 years). Event rates were estimated with the Kaplan-Meier method. The 30-day mortality rate was 0.5%. Repair was successful in 215 patients (96.0%). Leaflet resection was performed in 146 (72.6%), whereas 55 (27.4%) underwent ePTFE neochordae repair. All patients received an a...

Journal of Cardiothoracic and Vascular Anesthesia, 2009

Objective: B-type natriuretic peptide (BNP) has been established as a biomarker for heart failure... more Objective: B-type natriuretic peptide (BNP) has been established as a biomarker for heart failure. The objective was to evaluate BNP measured on arrival in the intensive care unit (ICU) as a predictor for heart failure defined as need for inotropic support or IABP beyond 24 hours postoperatively after aortic valve replacement.

Journal of Cardiothoracic and Vascular Anesthesia, 2011

To evaluate the prognostic implication of changes in postoperative B-type natriuretic peptide (BN... more To evaluate the prognostic implication of changes in postoperative B-type natriuretic peptide (BNP) concentrations in patients undergoing cardiopulmonary bypass for cardiac surgery. A retrospective analysis of prospectively collected clinical data. Cardiothoracic surgery and an intensive care unit (ICU) in a university hospital. The present study included a total of 407 consecutive patients undergoing cardiac surgery. None. BNP concentrations were measured on admittance to the ICU (D0) and at day 1 after surgery. Patients were divided into quintiles according to their BNP level on admittance to the ICU. The predictive value of absolute changes in BNP levels during the first 24 hours postoperatively was analyzed with Kaplan-Meier estimates of survival and Cox multivariate proportional analysis. Prognostic factors for impaired midterm survival included elevation of the BNP level (HR, 7.3/ log10(x); 95% confidence interval, 1.8-29, p = 0.005). The BNP levels of patients undergoing isolated valve surgery or valve and concomitant CABG surgery were significantly higher (p = 0.012 and p = 0.032, respectively) than those undergoing isolated coronary artery bypass graft surgery. Patients in higher quintiles required ventilation for a longer time (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and prolonged inotropic support (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The mean plasma BNP concentration of 172 pg/mL (median, 64; interquartile range, 172) on arrival at the ICU had a sensitivity of 75% and a specificity of 74% for predicting 1-year mortality. Elevated BNP levels on admittance to the ICU and postoperatively increasing BNP levels are associated with adverse postoperative outcome and are predictive of impaired late survival. Sequential postoperative BNP monitoring facilitates the early identification of patients at an increased risk of heart failure and may be used as an adjunct for clinical decision making and optimized patient management.

Journal of Cardiothoracic and Vascular Anesthesia, 2013

The aim of the present study was to evaluate acute kidney injury (AKI) with cystatin C following ... more The aim of the present study was to evaluate acute kidney injury (AKI) with cystatin C following transcatheter aortic valve implantation (TAVI) and to assess the impact of postoperative AKI on outcome and late renal function. A prospective study. Single, tertiary referral center. Sixty-eight consecutive patients with severe aortic stenosis and advanced comorbidity. Blood samples were collected on 4 occasions pre- and postoperatively to determine levels of s-creatinine and cystatin C. Additionally, a sample was collected at followup 12 months postoperatively for the determination of s-creatinine. The mean preoperative eGFR (s-creatinine) was 67±24 mL/min/1.73 m² compared to 45±21 mL/min/1.73 m² with eGFR (cystatin C) (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Postoperative AKI was diagnosed in 25 patients (39%) with eGFR (cystatin C), compared to 21 patients (33%) with GFR (s-creatinine) and the RIFLE criteria. The 90-day mortality was 14.3% for the AKI+group and 2.3% for the AKI-group (p = 0.099). At 12 months followup, renal function remained impaired in patients with postoperative AKI and deteriorated in patients without. The risk of postoperative AKI is considerable following TAVI, with an increased risk of early mortality for AKI+patients. Cystatin C may be a valuable adjunct to the established biomarker s-creatinine for preoperative risk assessment and for early postoperative diagnosis of AKI. The acute postoperative renal impairment in patients with AKI does not fully recover in the long term. There is a progressive renal impairment in both groups postoperatively, the etiology probably being multifactorial.

Journal of Cardiac Surgery, 2013

Chronic degenerative mitral regurgitation (MR) with left atrial (LA) enlargement is predictive of... more Chronic degenerative mitral regurgitation (MR) with left atrial (LA) enlargement is predictive of adverse cardiovascular events including stroke, atrial fibrillation (AF), and impaired survival. Mitral valve surgery (MVS) initiates left atrial reverse remodeling (LARR) characterized by LA volume reduction and improved function. The aim of this study was to evaluate the effects of LARR on clinical outcome in patients with and without LARR following MVS. A retrospective study was conducted of 137 consecutive patients in sinus rhythm with degenerative severe MR undergoing isolated MVS. The left atrial volume index (LAVi) was assessed by studying pre- and postoperative echocardiograms; LARR was defined as a reduction in LAVi ≥ 15%. Clinical outcome was evaluated in relation to the absolute and relative reduction in LAVi, and the presence or absence of postoperative LARR. The incidence of postoperative LARR was 74% (n = 101). The overall 90-day survival was 100%. Freedom from complications and cardiac events 10 years after surgery for patients with LARR versus those without was: 92 ± 4% versus 66 ± 13% (p = 0.088) for mortality; 72 ± 1% versus 51 ± 18% (p = 0.131) for new onset of chronic AF; 72 ± 1% versus 81 ± 6% (p = 0.477) for cerebral thromboembolism; and 50 ± 10% versus 49 ± 11% (p = 0.744) for major cardiac adverse events. Preoperative LA enlargement due to severe degenerative MR in patients with sinus rhythm demonstrates a high potential for postoperative reverse remodeling following MVS. The absence of postoperative LARR was not associated with an increase in the risk of postoperative mortality or adverse clinical events.

Journal of Cardiac Surgery, 2012

The aim of this study was to evaluate the impact of pulmonary hypertension (PH) on early and late... more The aim of this study was to evaluate the impact of pulmonary hypertension (PH) on early and late outcomes following surgery in patients with degenerative mitral regurgitation. The study included 270 patients who had undergone isolated mitral valve surgery (MVS) for leaflet prolapse during 1998 to 2010. Pulmonary artery systolic pressure (PASP) was measured with Doppler echocardiography pre- and postoperatively. The impact of PH (PASP &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 50 mmHg) on mortality and the potential for postoperative resolution of preoperatively elevated PASP was retrospectively analyzed. The incidence of PH was 27% (n = 74/270). Postoperative normalization, or reduction of preoperative PASP, was demonstrated in 87% of the patients with PH at a median of two months (interquartile range 1 to 19). Absent improvement or a postoperative increase in PASP was independently predicted by age (OR 1.08, 95% CI 1.02-1.14, p = 0.010). Preoperative PH resulted in a fourfold higher risk of postoperative mortality (HR 4.3, 95% CI 1.1-17.4, p = 0.039) during the first three years of follow-up. PH is an independent predictor of mortality during the initial three years following MVS. The majority of patients with PH demonstrated a reduction of preoperatively elevated PASP following surgery and the increased risk of mortality gradually decreased after three years. Our findings support early admission for mitral valve surgery before the occurrence of PH.

European Journal of Cardio-Thoracic Surgery, 2010

The present study evaluates the impact of prosthesis-patient mismatch (PPM) on left ventricular r... more The present study evaluates the impact of prosthesis-patient mismatch (PPM) on left ventricular remodelling following aortic valve replacement (AVR) for severe aortic insufficiency. In this study, 230 patients undergoing aortic valve surgery were divided into two groups depending on whether or not they exhibited PPM. Postoperative left ventricular (LV) dimensions and function were compared to the preoperative status. The incidence of PPM (EOAi &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or=0.85 cm(2) m(-2)) was 22.2%. There was no significant difference in the reduction of mean end-diastolic LV diameter (LVEDD; p=0.31) or mean end-systolic LV diameter (LVESD; p=0.79) between the non-PPM and the PPM groups. The LVEDD was reduced in the non-PPM group from 66+/-9 to 55+/-9 mm postoperatively (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) while the LVEDD in the PPM group was reduced from 65+/-9 to 56+/-10mm (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The LVESD was reduced in the non-PPM group from 49+/-10 to 40+/-10mm postoperatively (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) while the LVESD in the PPM group was reduced from 50+/-11 to 39+/-10mm (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Patients with preoperative LV dysfunction (ejection fraction (EF) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;50%) demonstrated a significant improvement in postoperative LVEF in both the non-PPM (36+/-8% to 44+/-12%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and PPM groups (33+/-7% to 46+/-11%, p=0.001) but no significant difference could be demonstrated in the rate of improvement between the two groups (p=0.23). Furthermore, no significant difference was found in survival between patients with PPM and those without (p=0.23). PPM did not influence left ventricular remodelling or survival following AVR for severe aortic insufficiency. The left ventricular remodelling process was initiated regardless of preoperative LVEF, and the impact of PPM seems to be of little importance.

Congenital Heart Disease, 2013

The surgical management of adults with congenital heart disease (ACHD) offers a great challenge, ... more The surgical management of adults with congenital heart disease (ACHD) offers a great challenge, with a large number of anomalies with complex pathophysiology necessitating specific treatments. Pre- and postoperative morbidity has been relatively high, and the influencing factors are not completely identified. We sought to evaluate the incidence and predictors of postoperative complications following surgery for ACHD centralized to a Swedish cardiothoracic center. Between April 2003 and May 2012, 191 consecutive patients with ACHD underwent 192 surgical procedures at our department. Pre-, intra-, and postoperative data were prospectively entered in a clinical database and retrospectively reviewed. Multivariate analysis was used to identify determinants of postoperative complications as a composite end point. The 30-day mortality was 0.5%. Overall survival was 98.3% ± 1.0 at 1 year and 98.3% ± 1.0 at 5 years postoperatively. Repeat sternotomy had to be performed in 94 patients (49%). New onset atrial fibrillation or flutter was the most prevalent (13%, n = 17/135) postoperative complication. Independent risk factors for major postoperative complications were age (odds ratio [OR] 1.81/10 year increment, P = 0.001; 95% confidence interval [CI] 1.29-2.53), reduced (&amp;amp;amp;amp;amp;amp;amp;lt;50%) systemic left ventricle ejection fraction (OR 3.61, P = 0.031; 95% CI 1.13-11.6), and the duration of cardiopulmonary bypass (OR 3.34/60 minute increase, P &amp;amp;amp;amp;amp;amp;amp;lt; 0.001; 95% CI 2.03-5.49). Our present data suggest that surgery in ACHD can be performed in centralized units with an excellent early and midterm survival. The incidence of postoperative complications was relatively low consisting mainly of supraventricular arrhythmias. In our opinion, ACHD surgery should be performed in centralized units with experienced surgeons in a dedicated multidisciplinary team for optimized postoperative management.

The Annals of Thoracic Surgery, 2008

Background. Bioprostheses for supraannular placement have been developed to optimize the hemodyna... more Background. Bioprostheses for supraannular placement have been developed to optimize the hemodynamic performance after aortic valve replacement. To evaluate the potential benefit of this design, we analyzed the influence of prosthesis-patient mismatch on diastolic function and left ventricular mass regression and evaluated the clinical performance of the Sorin Soprano and Medtronic Mosaic in the aortic position. Methods. A total of 372 patients underwent aortic valve replacement between July 2004 and February 2007, receiving either a Sorin Soprano (n ‫؍‬ 235) or a Medtronic Mosaic (n ‫؍‬ 137) prosthetic valve. Echocardiographic and clinical data were collected prospectively, and follow-up was performed in April 2007. Multivariate analyses were used to identify differences in hemodynamic performance, diastolic function, left ventricular mass regression, and predictors of impaired survival. Kaplan-Meier survival curves and log-rank tests were used to compare postoperative outcomes. Results. The 30-day mortality was 1.7% (4 of 235 patients) in the Sorin Soprano group and 2.9% (4 of 137 patients) in the Medtronic Mosaic group (p ‫؍‬ 0.473). Neither prosthesis-patient mismatch nor type of prosthesis was a significant predictor of early or late mortality. Diastolic heart failure was a predictor of poor survival (p ‫؍‬ 0.004); however, the recovery of diastolic function was not significantly influenced by prosthesis-patient mismatch. Neither moderate (indexed effective orifice area < 0.85 cm 2 /m 2 ) nor severe (indexed effective orifice area < 0.65 cm 2 /m 2 ) prosthesis-patient mismatch resulted in a significantly impaired left ventricular mass regression. Conclusions. Prosthesis-patient mismatch was not an independent predictor of poor survival, impaired left ventricular mass regression, or recovery of diastolic function. The Sorin Soprano and the Medtronic Mosaic bioprostheses demonstrated comparable hemodynamic performance and excellent clinical outcome without signs of structural valve deterioration during follow-up. (Ann Thorac Surg 2008;85:1310 -8)

The Annals of Thoracic Surgery, 2011

Background. Transcatheter aortic valve implantation (TAVI) is a therapeutic option for high-risk ... more Background. Transcatheter aortic valve implantation (TAVI) is a therapeutic option for high-risk patients with aortic stenosis. Procedural mortality remains high in comparison with conventional aortic valve replacement (AVR) because patients determined for TAVI are commonly denied conventional surgery. We aimed to evaluate access-related complications between the transfemoral (TF) and the transapical (TA) approach and to compare survival between TAVI and conventional AVR in propensity-score-matched patients.

European Journal of Cardio-Thoracic Surgery, 2011

The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is used to identify patient... more The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is used to identify patients at high risk for aortic valve replacement (AVR) in whom alternative procedures, such as trans-catheter aortic valve implantation (TAVI), may be appropriate. The aim of the present study was to calibrate and validate the EuroSCORE for different cardiac surgery procedures to improve patient selection for valve surgery. The study included 46516 patients undergoing open cardiac surgery during 2001-2007. A fivefold cross-validation technique was used to calibrate four different models. Model discrimination was determined by the area under the receiver operating characteristic (ROC) curve and model calibration by the Hosmer-Lemeshow (H-L) test. The actual and predicted 30-day mortality was 3.2%. The discrimination (ROC area) of the calibrated 30-day mortality prediction models was 0.79 for coronary bypass surgery, 0.77 for mitral valve surgery (MVS), and 0.75 for miscellaneous procedures, compared with 0.78 (p = 0.199), 0.74 (p = 0.077), and 0.72 (p = 0.001), respectively, for the original EuroSCORE. The discrimination for AVR was the same for the calibrated and the original EuroSCORE model (0.70). The H-L test gave a p-value of 0.104 for the calibrated and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 for the original EuroSCORE model. A calibration of EuroSCORE resulted in an acceptable predictive capacity for 30-day mortality, and improved discrimination and calibration for MVS and miscellaneous procedures. However, the poor discriminatory for the AVR procedure suggests that the EuroSCORE may not be satisfying for assessing risk prior to TAVI and that more optimized risk stratification models may be needed.