BACKGROUND: Although results in valvular heart surgery may be improving, too few cases are available in most centers to quantify changes, especially for uncommon procedural categories. This study examined comprehensively national trends in valve surgery outcomes over the past 15 years. METHODS: From 1993 through 2007, 623,039 valve procedures were grouped into single aortic (A), mitral (M), and tricuspid (T) operations, along with AM, MT, AT, and AMT multiple valves ± coronary artery bypass graft surgery. Pulmonary valve surgery was excluded. Trends in baseline characteristics were documented, and logistic regression adjusted for differences in patient profiles. Outcomes were expressed as unadjusted operative mortality, adjusted odds ratios for mortality, and a composite of mortality and major complications. RESULTS: Single valves comprised 89% of valve surgery and multiple valves, 11%. Preoperative patient risk profiles worsened over time. Mortality rates were higher for multiple valves, but all mortality rates fell significantly over the 15 years (p <0.001). The composite of mortality and major morbidity did not improve, however, largely because of increasing pulmonary/infectious complications. Overall, cardiac etiology accounted for 54% of deaths, and pulmonary/infectious etiologies for 16%. Cardiac etiology of death fell by 16% over time, but pulmonary death and complications increased by 78% and 39%, respectively. CONCLUSIONS: Preoperative patient profiles for cardiac valve procedures have worsened over time. Risk-adjusted mortalities have fallen for all valve surgery, but remain higher for multiple valves. The finding of increasing pulmonary deaths and complications suggests that prevention and improved management of pulmonary and infectious complications could be an important focus for quality improvement.
BACKGROUND: Although results in valvular heart surgery may be improving, too few cases are available in most centers to quantify changes, especially for uncommon procedural categories. This study examined comprehensively national trends in valve surgery outcomes over the past 15 years. METHODS: From 1993 through 2007, 623,039 valve procedures were grouped into single aortic (A), mitral (M), and tricuspid (T) operations, along with AM, MT, AT, and AMT multiple valves ± coronary artery bypass graft surgery. Pulmonary valve surgery was excluded. Trends in baseline characteristics were documented, and logistic regression adjusted for differences in patient profiles. Outcomes were expressed as unadjusted operative mortality, adjusted odds ratios for mortality, and a composite of mortality and major complications. RESULTS: Single valves comprised 89% of valve surgery and multiple valves, 11%. Preoperative patient risk profiles worsened over time. Mortality rates were higher for multiple valves, but all mortality rates fell significantly over the 15 years (p <0.001). The composite of mortality and major morbidity did not improve, however, largely because of increasing pulmonary/infectious complications. Overall, cardiac etiology accounted for 54% of deaths, and pulmonary/infectious etiologies for 16%. Cardiac etiology of death fell by 16% over time, but pulmonary death and complications increased by 78% and 39%, respectively. CONCLUSIONS: Preoperative patient profiles for cardiac valve procedures have worsened over time. Risk-adjusted mortalities have fallen for all valve surgery, but remain higher for multiple valves. The finding of increasing pulmonary deaths and complications suggests that prevention and improved management of pulmonary and infectious complications could be an important focus for quality improvement.
Authors: Orlando Santana; Steve Xydas; Roy F Williams; Angelo LaPietra; Maurice Mawad; Frederick Hasty; Esteban Escolar; Christos G Mihos Journal: J Thorac Dis Date: 2017-06 Impact factor: 2.895
Authors: Benjamin A Steinberg; Yue Zhao; Xia He; Adrian F Hernandez; David A Fullerton; Kevin L Thomas; Roger Mills; Winslow Klaskala; Eric D Peterson; Jonathan P Piccini Journal: Clin Cardiol Date: 2013-12-18 Impact factor: 2.882
Authors: Peter K Smith; John D Puskas; Deborah D Ascheim; Pierre Voisine; Annetine C Gelijns; Alan J Moskowitz; Judy W Hung; Michael K Parides; Gorav Ailawadi; Louis P Perrault; Michael A Acker; Michael Argenziano; Vinod Thourani; James S Gammie; Marissa A Miller; Pierre Pagé; Jessica R Overbey; Emilia Bagiella; François Dagenais; Eugene H Blackstone; Irving L Kron; Daniel J Goldstein; Eric A Rose; Ellen G Moquete; Neal Jeffries; Timothy J Gardner; Patrick T O'Gara; John H Alexander; Robert E Michler Journal: N Engl J Med Date: 2014-11-18 Impact factor: 91.245
Authors: Donald S Likosky; Amelia S Wallace; Richard L Prager; Jeffrey P Jacobs; Min Zhang; Steven D Harrington; Paramita Saha-Chaudhuri; Patricia F Theurer; Astrid Fishstrom; Rachel S Dokholyan; David M Shahian; J Scott Rankin Journal: Ann Thorac Surg Date: 2015-08-28 Impact factor: 4.330
Authors: Alexander A Brescia; Sarah T Ward; Tessa M F Watt; Liza M Rosenbloom; Megan Baker; Shazli Khan; Emilie Ziese; Matthew A Romano; Steven F Bolling Journal: Ann Thorac Surg Date: 2019-08-31 Impact factor: 4.330
Authors: Philippe Unger; Marie-Annick Clavel; Brian R Lindman; Patrick Mathieu; Philippe Pibarot Journal: Nat Rev Cardiol Date: 2016-04-28 Impact factor: 32.419