{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T23:04:35Z","timestamp":1780009475001,"version":"3.53.1"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Risk estimation for cardiac procedures is essential for clinical decision-making. The aim of the study is to validate the recently introduced Society of Thoracic Surgeons (STS) risk score model for mitral valve repair (MVr) in degenerative mitral regurgitation (DMR) by investigating a large cohort undergoing minimally invasive MVr (MI-MVr).<\/jats:p>\n                  <jats:p>A total of 1,081 consecutive patients with DMR undergoing non-emergent MI-MVr were retrospectively analyzed. The primary study endpoint was 30-day all-cause mortality (OM), while secondary endpoints were major morbidity and mortality (MM) and conversion-to-replacement (CONV). Predictive discrimination and calibration of the models were measured using receiver operating characteristic (ROC) analysis.<\/jats:p>\n                  <jats:p>A 30-day mortality of 0.55% was observed in the study cohort. All risk scores were significantly higher in non-survivors. Like existing risk models, the intention-to-treat-OM (ITT-OM) model was predictive for OM (OR: 2.078, 95% CI: 1.324\u20133.621; p\u2009=\u20090.001), but its discriminatory ability was limited based on ROC analysis. EuroSCORE II showed the best discriminatory performance for mortality among the investigated models. Furthermore, second cross-clamping and CONV were independent predictors of OM (OR: 26.2, 95% CI: 4.3\u2013160.0; p\u2009&lt;\u20090.001 and OR: 12.8, 95% CI: 1.8\u201389.2; p\u2009=\u20090.010). The ITT-MM and ITT-CONV models demonstrated an acceptable discriminatory ability for predicting operative MM and CONV.<\/jats:p>\n                  <jats:p>The ITT-based risk model was validated in our study cohort undergoing MI-MVr for DMR, showing only limited discriminatory performance for mortality, while the EuroSCORE II demonstrated better discrimination for mortality despite systematic overestimation. This is the first report validating the recently introduced model. However, further studies with larger cohorts are needed to overcome the limitations of the present study.<\/jats:p>","DOI":"10.1055\/a-2650-6994","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T23:22:57Z","timestamp":1752880977000},"page":"324-331","source":"Crossref","is-referenced-by-count":1,"title":["Validation of a Risk Calculator for Surgical Repair of Primary Mitral Regurgitation"],"prefix":"10.1055","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3479-4537","authenticated-orcid":false,"given":"Serdar","family":"Akansel","sequence":"additional","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany"},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Dini","sequence":"additional","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany"},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon H.","family":"S\u00fcndermann","sequence":"additional","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany"},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin, Germany"},{"name":"German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany"},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin, Germany"},{"name":"German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volkmar","family":"Falk","sequence":"additional","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany"},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin, Germany"},{"name":"German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany"},{"name":"ETH Zurich, Department of Health Sciences and Technology, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Kempfert","sequence":"additional","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany"},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin, Germany"},{"name":"German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Kofler","sequence":"additional","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany"},{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin, Germany"},{"name":"German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,7,18]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1093\/ejcts\/ezs043","article-title":"EuroSCORE II","volume":"41","author":"S AM Nashef","year":"2012","journal-title":"Eur J Cardiothorac Surg"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"2265","DOI":"10.1016\/j.athoracsur.2015.11.049","article-title":"The Society of Thoracic Surgeons Mitral Repair\/Replacement Composite Score: A report of The Society of Thoracic Surgeons Quality Measurement Task Force","volume":"101","author":"V Badhwar","year":"2016","journal-title":"Ann Thorac 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A multicentre validation study","volume":"34","author":"F Barili","year":"2013","journal-title":"Eur Heart J"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"3049","DOI":"10.1016\/j.jtcvs.2014.07.039","article-title":"Performance of the European System for Cardiac Operative Risk Evaluation II: a meta-analysis of 22 studies involving 145,592 cardiac surgery procedures","volume":"148","author":"P Guida","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/j.athoracsur.2018.03.086","article-title":"Isolated mitral valve surgery: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis","volume":"106","author":"J S Gammie","year":"2018","journal-title":"Ann Thorac Surg"},{"issue":"07","key":"ref8","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1016\/j.jacc.2022.11.017","article-title":"Risk of surgical mitral valve repair for primary mitral regurgitation","volume":"81","author":"V Badhwar","year":"2023","journal-title":"J Am Coll Cardiol"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1093\/ejcts\/ezs455","article-title":"Guidelines on the management of valvular heart disease (version 2012): the joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"A Vahanian","year":"2012","journal-title":"Eur J Cardiothorac Surg"},{"issue":"04","key":"ref10","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1093\/ejcts\/ezx324","article-title":"2017 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"52","author":"V Falk","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"ezad212","DOI":"10.1093\/ejcts\/ezad212","article-title":"Image-based ring size prediction for mitral valve repair","volume":"64","author":"S Akansel","year":"2023","journal-title":"Eur J Cardiothorac Surg"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"ivac163","DOI":"10.1093\/icvts\/ivac163","article-title":"Minimally invasive mitral valve surgery after failed transcatheter mitral valve repair in an intermediate-risk cohort","volume":"35","author":"S Akansel","year":"2022","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"02","key":"ref13","first-page":"83","article-title":"Endoaortic balloon occlusion in minimally invasive mitral valve surgery","volume":"2022","author":"K M Van Praet","year":"2022","journal-title":"Multimed Man Cardiothorac Surg"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1093\/ejcts\/ezt657","article-title":"Risk stratification for in-hospital mortality after cardiac surgery: external validation of EuroSCORE II in a prospective regional registry","volume":"46","author":"D Paparella","year":"2014","journal-title":"Eur J Cardiothorac Surg"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1093\/ejcts\/ezt122","article-title":"Comparison of the EuroSCORE II and Society of Thoracic Surgeons 2008 risk tools","volume":"44","author":"B H Kirmani","year":"2013","journal-title":"Eur J Cardiothorac Surg"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1093\/ejcts\/ezaa403","article-title":"Is the EuroSCORE II reliable in surgical mitral valve repair? A single-centre validation study","volume":"59","author":"D Carino","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"issue":"02","key":"ref19","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.athoracsur.2019.11.047","article-title":"Misclassification of mitral valve disease and rate of surgical repair in The Society of Thoracic Surgeons database","volume":"110","author":"M Hamandi","year":"2020","journal-title":"Ann Thorac Surg"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/HCO.0000000000000498","article-title":"Developing a mitral valve center of excellence","volume":"33","author":"A El-Eshmawi","year":"2018","journal-title":"Curr Opin Cardiol"}],"container-title":["The Thoracic and Cardiovascular Surgeon"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2650-6994.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T22:46:07Z","timestamp":1780008367000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2650-6994"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,18]]},"references-count":18,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2026,5,28]]},"published-print":{"date-parts":[[2026,6]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2650-6994","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0171-6425","1439-1902"],"issn-type":[{"value":"0171-6425","type":"print"},{"value":"1439-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,18]]}}}