The study Results of the ARGEN-CCV Argentine Registry of Cardiovascular Surgery is a fundamental contribution to the evaluation of cardiac surgery in Argentina, presenting prospective and multicenter data on operative mortality and early outcomes. (1) The implementation of national registries is a key strategy for improving the quality of care and allows local results to be placed in the context of international standards, particularly those established by the Society of Thoracic Surgeons (STS) and the European Association for Cardio-Thoracic Surgery (EACTS).

The STS Adult Cardiac Surgery Database is currently one of the most robust clinical registries worldwide, with thousands of procedures included and a high degree of standardization in the definition of operative mortality and risk adjustment. Contemporary STS reports show that the observed mortality for isolated myocardial revascularization surgery remains around 1%, while isolated valve surgery has values close to 1-2%, with significant increases in combined or more complex procedures depending on the clinical characteristics of the patient undergoing surgery. (2) These data have been consolidated as international benchmarks for quality assessment.

Similarly, the EACTS has developed its Adult Cardiac Database, which allows surgical outcomes in multiple European countries to be analyzed and mortality rates between different centers to be compared. Publications derived from this database and using its risk score (EUROSCORE II) have reported mortality rates comparable to those of the STS for isolated procedures, with a progressive increase in multivalve or combined surgeries, reflecting the impact of surgical complexity and patient risk profile. (3)

In this context, the mortality rates reported by the ARGEN-CCV should be interpreted taking into account the heterogeneity of the participating centers and the characteristics of the Argentine health system and its patients. The marked socioeconomic inequality in Argentina has been linked to a significant increase in postoperative in-hospital mortality in cardiovascular surgery. Patients from lower-income households had lower health insurance coverage, a greater proportion of emergency surgeries, a higher burden of comorbidities, and more limited access to specialized care centers, which impact postoperative outcomes. (4) Therefore, the overall results of the registry are not within ranges comparable to those reported by the STS and EACTS for similar procedures, especially in isolated surgeries, suggesting that there is a lot of work ahead of us to align ourselves with international standards.

A relevant aspect highlighted by recent publications from both STS and EACTS is the need to look beyond in-hospital or 30-day mortality. Contemporary studies have shown that a significant proportion of deaths related to cardiac surgery occur after discharge, which may underestimate the real impact of the procedure if restrictive definitions are used. (5) In this regard, the ARGEN-CCV offers a platform with the potential to evolve towards longer follow-up models and even more robust comparisons, since patients are generally operated on and definitely discharged from the same institution.

In conclusion, the ARGEN-CCV represents a strategic initiative for Argentine cardiovascular surgery. It is essential to maintain databases in which all cardiovascular centers in the country participate. This will reinforce its value as a tool for quality assessment and future planning, and lay the foundation for continuous improvement based on reliable and internationally comparable data.

We appreciate Dr. Parodi's letter and comments. We would like to point out that an attempt was made to follow up patients after hospitalization, but this was frustrated by the lack of adherence by many researchers to data collection, which is why the little information we had obtained was dismissed and only the follow-up during hospitalization remained.

On the other hand, it is worth clarifying that the registry was not designed to validate data with the most commonly used scores.

We fully agree with Dr. Parodi's comments about the need for larger registries with longer follow-up and covering as many centers as possible at the federal level. Permanent and updated registries will be necessary to take these results into account and eventually validate them with the scores currently in use.