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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Risk Assessment in Cannulation for Minimally Invasive Heart Valve Surgery: The Modified HOSTILE Score

by
Jacqueline Kruse
1,*,†,
Miriam Silaschi
1,†,
Michael Celik
1,
Marwan Hamiko
1,
Eissa Alaj
1,
Hossien Alirezaei
1,
Atsushi Sugiura
2,
Enzo Lüsebrink
2,
Sebastian Zimmer
2 and
Farhad Bakhtiary
1
1
Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany
2
Department of Medicine II, Heart Center Bonn, University Hospital Bonn, 53127 Bonn, Germany
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2026, 15(2), 843; https://doi.org/10.3390/jcm15020843
Submission received: 24 November 2025 / Revised: 8 January 2026 / Accepted: 13 January 2026 / Published: 20 January 2026
(This article belongs to the Special Issue Advances in Cardiovascular Computed Tomography (CT))
Versions Notes

Abstract

Objectives: The HOSTILE score was developed to assess femoral access challenges in transcatheter valve therapy. Similar vascular issues arise in femoral cannulation for minimally invasive valve surgery, making CT-based planning essential. We adapted the score for surgical use (MOD-HOSTILE) and evaluated its association with neurological and adverse outcomes. Methods: In this single-center retrospective study, the MOD-HOSTILE score (0–11 points) was calculated for 364 patients undergoing minimally invasive heart valve surgery from 2019 to 2023. Patients were stratified into low (0–2), mild (>2–5), and high (>5–11) score categories. Outcomes included 30-day stroke, other neurological events, and perioperative complications. Results: High MOD-HOSTILE patients were significantly older (70 [64.7–73.0] vs. 61 [60.0–63.0] years; p < 0.01) and had higher surgical risk (EuroSCORE II 1.79 [1.26–2.16] vs. 0.83 [0.75–0.94]; p < 0.01). Neurological complications were more frequent in the high MOD-HOSTILE group, including stroke (8.7% vs. 0.9%; p = 0.02) and hemiplegia (13.0% vs. 0.9%; p < 0.01). Axillary cannulated patients had higher MOD-HOSTILE scores than femoral cannulated patients. Stroke risk was highest in patients with high MOD-HOSTILE score undergoing axillary cannulation (high vs. low MOD-HOSTILE, 18.2% vs. 0%; p = 0.04). Thirty-day mortality was comparable between groups (p = 0.09). MOD-HOSTILE predicted stroke with an AUC of 0.78 (95% CI 0.73–0.82) and OR 1.4 per point (95% CI 1.1–2.0). Conclusions: The MOD-HOSTILE score identifies vascular and neurological risk in minimally invasive valve surgery, with scores ≥5 indicating elevated risk of stroke and delirium. Patients with high scores may benefit from alternative surgical strategies.
Keywords: minimally invasive heart valve surgery; CT imaging; risk assessment minimally invasive heart valve surgery; CT imaging; risk assessment

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MDPI and ACS Style

Kruse, J.; Silaschi, M.; Celik, M.; Hamiko, M.; Alaj, E.; Alirezaei, H.; Sugiura, A.; Lüsebrink, E.; Zimmer, S.; Bakhtiary, F. Risk Assessment in Cannulation for Minimally Invasive Heart Valve Surgery: The Modified HOSTILE Score. J. Clin. Med. 2026, 15, 843. https://doi.org/10.3390/jcm15020843

AMA Style

Kruse J, Silaschi M, Celik M, Hamiko M, Alaj E, Alirezaei H, Sugiura A, Lüsebrink E, Zimmer S, Bakhtiary F. Risk Assessment in Cannulation for Minimally Invasive Heart Valve Surgery: The Modified HOSTILE Score. Journal of Clinical Medicine. 2026; 15(2):843. https://doi.org/10.3390/jcm15020843

Chicago/Turabian Style

Kruse, Jacqueline, Miriam Silaschi, Michael Celik, Marwan Hamiko, Eissa Alaj, Hossien Alirezaei, Atsushi Sugiura, Enzo Lüsebrink, Sebastian Zimmer, and Farhad Bakhtiary. 2026. "Risk Assessment in Cannulation for Minimally Invasive Heart Valve Surgery: The Modified HOSTILE Score" Journal of Clinical Medicine 15, no. 2: 843. https://doi.org/10.3390/jcm15020843

APA Style

Kruse, J., Silaschi, M., Celik, M., Hamiko, M., Alaj, E., Alirezaei, H., Sugiura, A., Lüsebrink, E., Zimmer, S., & Bakhtiary, F. (2026). Risk Assessment in Cannulation for Minimally Invasive Heart Valve Surgery: The Modified HOSTILE Score. Journal of Clinical Medicine, 15(2), 843. https://doi.org/10.3390/jcm15020843

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